Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA; Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA; Department of Anesthesia and Critical Care, University of Massachusetts Medical School, Worcester, MA 01655, USA.
J Crit Care. 2019 Apr;50:262-268. doi: 10.1016/j.jcrc.2019.01.006. Epub 2019 Jan 11.
To examine clinical factors, including established electroencephalography (EEG) consensus recommendations, that may influence EEG-prescription in critically-ill intracerebral hemorrhage (ICH) patients in the neurointensive care unit.
Retrospective analysis of 330 ICH patients admitted to a neurointensive care unit at an academic medical center between 01/2013-12/2015. We compared EEG prescription patterns with current EEG consensus recommendations, and employed univariate and multivariable logistic regression modeling to determine clinical variables associated with EEG ordering.
Seventy-eight (41%) of 190 subjects underwent EEG in accordance with EEG-consensus guidelines, demonstrating an overall accuracy (probability that EEG prescription aligned with EEG consensus recommendations) of 64.6% (95%-CI59.1-69.7). Factors independently associated with EEG ordering included fulfillment of EEG consensus recommendations, lower admission Glasgow Coma Scale (GCS), and presence of clinical seizures. The unadjusted and adjusted C-statistics for fulfillment of consensus recommendations was 0.74 (95%-CI 0.69-0.80) and 0.85 (95%-CI 0.81-0.90), respectively. Among 83 subjects undergoing EEG (25.2%), EEG findings informed clinical decision-making in 50 patients (60%).
EEG appeared underused in ICH, since <50% of patients who fulfilled guideline criteria underwent EEG. Prescription of EEG was related to factors beyond those included in consensus recommendations. Validation of our findings and their association with outcome is required.
检查可能影响神经重症监护病房中危重症脑出血（ICH）患者脑电图（EEG）医嘱的临床因素，包括已确立的脑电图共识建议。
对 2013 年 1 月至 2015 年 12 月期间在一家学术医疗中心的神经重症监护病房住院的 330 例 ICH 患者进行回顾性分析。我们比较了脑电图医嘱模式与当前脑电图共识建议，并采用单变量和多变量逻辑回归模型确定与脑电图医嘱相关的临床变量。
190 例患者中有 78 例（41%）根据脑电图共识指南进行了脑电图检查，总体准确性（脑电图医嘱与脑电图共识建议一致的概率）为 64.6%（95%可信区间 59.1-69.7）。与脑电图医嘱相关的独立因素包括满足脑电图共识建议、入院格拉斯哥昏迷量表（GCS）评分较低以及存在临床癫痫发作。满足共识建议的未调整和调整后的 C 统计量分别为 0.74（95%可信区间 0.69-0.80）和 0.85（95%可信区间 0.81-0.90）。在 83 例行脑电图检查的患者（25.2%）中，50 例（60%）患者的脑电图结果影响了临床决策。
由于满足指南标准的患者中只有不到 50%接受了脑电图检查，因此在 ICH 中脑电图的应用不足。脑电图的开具与共识建议之外的因素有关。需要验证我们的发现及其与结果的相关性。
