Sánchez Fernández Iván, Sansevere Arnold J, Guerriero Rejean M, Buraniqi Ersida, Pearl Phillip L, Tasker Robert C, Loddenkemper Tobias
Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Epilepsia. 2017 Mar;58(3):420-428. doi: 10.1111/epi.13653. Epub 2017 Jan 28.
To identify factors associated with in-hospital mortality in neonates and children undergoing continuous electroencephalography (cEEG) monitoring in the intensive care unit (ICU).
We performed a retrospective observational study in patients from birth to 21 years of age who underwent clinically indicated cEEG in the ICU from 2011 to 2013. The main outcome measure was in-hospital mortality.
Six-hundred and twenty-five patients (54.2% male) met eligibility criteria, of whom 211 were neonates (55% male, 24.8% premature) and 414 were pediatric patients (53.9% male). Electrographic seizures occurred in 176 patients (28.2%) and status epilepticus (SE) occurred in 20 (11.4%). The time from ICU admission to cEEG initiation was 16.7 (5.1-94.4) h. Eighty-nine patients (14.2%) (30 [14.2%] neonates, and 59 [14.3%] pediatric patients) died in the hospital. In neonates-after controlling for gender and prematurity-independent factors associated with mortality were prematurity (odds ratio [OR] 2.63. 95% confidence interval [CI] 1.06-6.5, p = 0.037), presence of status epilepticus (SE); OR 8.82, 95% CI 1.74-44.57, p = 0.008), and time from ICU admission to initiation of cEEG (OR 1.002, 95% CI 1.001-1.004 per hour, p = 0.008]. In pediatric patients-after controlling for gender and age-independent factors associated with mortality were the absence of seizures factors associated with mortality were absence of seizures (OR = 4.3, (95% CI: 1.5-12.4), p = 0.007), the presence of SE (OR 7.76, 95% CI 1.47-40.91, p = 0.016), and the time from ICU admission to initiation of cEEG (OR 1.001, 95% CI 1.0002-1.001, per hour, p = 0.005].
Both presence of electrographic SE and time from ICU admission to cEEG initiation were independent factors associated with mortality in neonates and pediatric patients with cEEG in the ICU.
确定重症监护病房（ICU）中接受连续脑电图（cEEG）监测的新生儿和儿童院内死亡的相关因素。
我们对2011年至2013年在ICU接受临床指征cEEG检查的出生至21岁患者进行了一项回顾性观察研究。主要结局指标是院内死亡率。
625例患者（54.2%为男性）符合纳入标准，其中211例为新生儿（55%为男性，24.8%为早产儿），414例为儿科患者（53.9%为男性）。176例患者（28.2%）出现脑电图癫痫发作，20例（11.4%）出现癫痫持续状态（SE）。从ICU入院到开始cEEG监测的时间为16.7（5.1 - 94.4）小时。89例患者（14.2%）（30例[14.2%]新生儿和59例[14.3%]儿科患者）在医院死亡。在新生儿中，在控制性别和早产因素后，与死亡率相关的独立因素为早产（比值比[OR]2.63，95%置信区间[CI]1.06 - 6.5，p = 0.037）、癫痫持续状态（SE）的存在（OR 8.82，95%CI 1.74 - 44.57，p = 0.008）以及从ICU入院到开始cEEG监测的时间（OR 1.002，95%CI 1.001 - 1.004每小时，p = 0.008）。在儿科患者中，在控制性别和年龄因素后，与死亡率相关的独立因素为无癫痫发作（OR = 4.3，[95%CI：1.5 - 12.4]，p = 0.007）、SE的存在（OR 7.76，95%CI 1.47 - 40.91，p = 0.016）以及从ICU入院到开始cEEG监测的时间（OR 1.001，95%CI 1.0002 - 1.001每小时，p = 0.005）。
脑电图SE的存在以及从ICU入院到开始cEEG监测的时间都是ICU中接受cEEG监测的新生儿和儿科患者死亡率的独立相关因素。
