Efficacy of continuous EEG for management of altered mental status in the neurosurgical ICU Michael Ohene-Adjei, MS
1 BA,
Richard Temes,
Donald and Barbara Zucker School of Medicine at
1,2 MD,
Brendan Ryu,
1 Hofstra/Northwell , and
Background
Results
• Patients in the neurosurgical ICU may sustain mental altered status due to many causes • Standard measures for patient evaluation (ensuring normal vital signs, ruling out infection, and neuroimaging) may not fully explain these declines. • After these standard evaluations have been done, electroencephalogram (EEG) is often used to rule out subclinical seizures as a cause of altered mental status. • Previous studies have looked at the general use of EEG for neurosurgical ICU patients but none have looked at the efficacy of EEGs detecting subclinical seizures in patients with altered mental status.
Baseline Characteristics
Hypothesis • Continuous EEG monitoring, done as a screening tool for patients with unexplained altered mental status alteration in Neurosurgical ICU, rarely if ever yields clinically significant changes in treatment.
Variables Age (yrs) Gender Male Female Brain Tumor Present Absent Patient Outcomes Positive Neutral Negative
1 BA,
Michael Schulder,
the Department of Neurosurgery at the DBZSOM
2
Patient Outcomes Negative Positive Total Subclinical Yes Seizures No
Patients (n=100) 62 ± 19 57% 43% 16% 84% 24% 4% 72%
Table 1: Baseline Characteristics of Patients
1,2 MD
13 59 72
Chi square value
3* 25 28
16 84 100
p = 0.36
Table 2: 2x2 of patient subclinical seizure diagnosis and outcome. * No patient who had subclinical seizures and had a positive outcome had their treatment course altered due to the results of their EEG.
Conclusions • Subclinical seizures were detected in only 16% of patients. This incidence was comparably lower than those in prior reports. • EEG done in the neurosurgical ICU to explain altered mental status in the absence of clinically evident seizures did not yield a significant change in patient management.
Methods
Future Directions
• A retrospective chart review was conducted consisting of patients who were admitted to the North Shore University Hospital neurosurgical ICU from 2015-2020, and who underwent EEG for unexplained altered mental status. • Patient outcomes were categorized as positive (patients being discharged from the hospital), neutral (patients being transferred to another care facility [e.g. inpatient rehab or palliative care]), or negative (death). • Age, gender, presence of a brain tumor, incidence of subclinical seizure detection, and treatment outcome were noted.
• Stratify patients by diagnosis on admission and test if there is any association with subclinical seizure detection. • Analyze our results vs. those of other centers to discern why our incidence of subclinical seizures was lower.
Figure 1: Percentage of patients with a subclinical seizure detected