Epilepsy Division, Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, U.S.A.
J Clin Neurophysiol. 2019 Sep;36(5):358-364. doi: 10.1097/WNP.0000000000000594.
Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery.
The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P < 0.05 was considered significant.
For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19-0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79-5.93; P < 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34-8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale (≥12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58-170.19; P = 0.02).
Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care.
连续脑电图（cEEG）监测主要用于诊断癫痫发作和癫痫持续状态，并对心肺骤停后的预后进行预测。本研究旨在探讨 cEEG 是否可预测生存和有意义的恢复。
作者回顾了 2013 年 1 月至 2015 年 11 月期间获得的住院 cEEG 报告，并记录了人口统计学数据、入院前改良 Rankin 量表、既往癫痫病史、入住重症监护病房的格拉斯哥昏迷量表，以及脑电图数据（后优势节律、反应性、癫痫样放电、癫痫发作和癫痫持续状态）。采用逻辑回归模型评估临床结局（死亡与存活或有意义的恢复[住院康复、家庭康复或家庭]与其他[死亡、熟练护理机构]）与 cEEG 结果之间的关联。P<0.05 被认为具有统计学意义。
在 218 份 cEEG 报告（197 例重症监护病房患者）中，至少存在单侧后优势节律与存活相关（死亡的优势比为 0.38；95%置信区间，0.19-0.77；P=0.01），与有意义的结局相关（优势比为 3.26；95%置信区间，1.79-5.93；P<0.001）；在校正入院前残疾后，后优势节律仍然具有统计学意义。有既往癫痫病史的患者有更好的有意义恢复机会（优势比，3.31；95%CI，1.34-8.17；P=0.001）。治疗性癫痫发作和癫痫持续状态与死亡率（P=0.6）或处置（P=0.6）无关。重症监护病房入院时格拉斯哥昏迷量表评分较高（≥12）与有意义的恢复相关（优势比，16.40；95%置信区间，1.58-170.19；P=0.02）。
连续脑电图结果可用于预测生存和功能恢复，并为确定护理目标提供指导。
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