Li Jimmy, Toffa Dènahin Hinnoutondji, Bou Assi Elie, Mehrpouyan Sepehr, Forand Julie, Robert Manon, Keezer Mark, Flahault Adrien, Nguyen Dang Khoa
Neurosciences Department, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Neurology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Can J Neurol Sci. 2021 Sep;48(5):640-647. doi: 10.1017/cjn.2020.268. Epub 2020 Dec 14.
Intervention time (IT) in response to seizures and adverse events (AEs) have emerged as key elements in epilepsy monitoring unit (EMU) management. We performed an audit of our EMU, focusing on IT and AEs.
We performed a retrospective study on all clinical seizures of admissions over a 1-year period at our Canadian academic tertiary care center's EMU. This EMU was divided in two subunits: a daytime three-bed epilepsy department subunit (EDU) supervised by EEG technicians and a three-bed neurology ward subunit (NWU) equipped with video-EEG where patients were transferred to for nights and weekends, under nursing supervision. Among 124 admissions, 58 were analyzed. A total of 1293 seizures were reviewed to determine intervention occurrence, IT, and AE occurrence. Seizures occurring when the staff was present at bedside at seizure onset were analyzed separately.
Median IT was 21.0 (11.0-40.8) s. The EDU, bilateral tonic-clonic seizures (BTCS), and the presence of a warning signal were associated with increased odds of an intervention taking place. The NWU, BTCS, and seizure rank (seizures were chronologically ordered by the patient for each subunit) were associated with longer ITs. Bedside staff presence rate was higher in the EDU than in the NWU (p < 0.001). AEs occurred in 19% of admissions, with no difference between subunits. AEs were more frequent in BTCS than in other seizure types (p = 0.001).
This study suggests that close monitoring by trained staff members dedicated to EMU patients is key to optimize safety. AE rate was high, warranting corrective measures.
对癫痫发作和不良事件的干预时间（IT）已成为癫痫监测单元（EMU）管理的关键要素。我们对我们的EMU进行了一次审核，重点关注IT和不良事件。
我们对加拿大一所学术三级护理中心的EMU在1年期间收治的所有临床癫痫发作进行了回顾性研究。该EMU分为两个亚单元：一个由脑电图技术人员监督的日间三张床位的癫痫科亚单元（EDU），以及一个配备视频脑电图的三张床位的神经科病房亚单元（NWU），患者在夜间和周末被转至该病房，由护理人员监督。在124例入院患者中，分析了58例。共审查了1293次癫痫发作，以确定干预的发生情况、IT和不良事件的发生情况。对发作开始时工作人员在床边的癫痫发作进行了单独分析。
IT的中位数为21.0（11.0 - 40.8）秒。EDU、双侧强直阵挛发作（BTCS）以及存在预警信号与进行干预的几率增加相关。NWU、BTCS和癫痫发作顺序（每个亚单元中患者按时间顺序排列癫痫发作）与更长的IT相关。EDU的床边工作人员在场率高于NWU（p < 0.001）。19%的入院患者发生了不良事件，各亚单元之间无差异。BTCS中不良事件比其他癫痫发作类型更频繁（p = 0.001）。
本研究表明，由专门负责EMU患者的训练有素的工作人员进行密切监测是优化安全性的关键。不良事件发生率较高，需要采取纠正措施。
