Amerineni Rajesh, Sun Haoqi, Fernandes Marta Bento, Westover M Brandon, Moura Lidia, Patorno Elisabetta, Hsu John, Zafar Sahar F
Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A.
Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A.
J Clin Neurophysiol. 2025 Jan 1;42(1):20-27. doi: 10.1097/WNP.0000000000001043. Epub 2023 Oct 30.
Continuous electroencephalography (cEEG) is recommended for hospitalized patients with cerebrovascular diseases and suspected seizures or unexplained neurologic decline. We sought to (1) identify areas of practice variation in cEEG utilization, (2) determine predictors of cEEG utilization, (3) evaluate whether cEEG utilization is associated with outcomes in patients with cerebrovascular diseases.
This cohort study of the Premier Healthcare Database (2014-2020), included hospitalized patients age > 18 years with cerebrovascular diseases (identified by ICD codes). Continuous electroencephalography was identified by International Classification of Diseases (ICD)/Current Procedural Terminology (CPT) codes. Multivariable lasso logistic regression was used to identify predictors of cEEG utilization and in-hospital mortality. Propensity score-matched analysis was performed to determine the relation between cEEG use and mortality.
1,179,471 admissions were included; 16,777 (1.4%) underwent cEEG. Total number of cEEGs increased by 364% over 5 years (average 32%/year). On multivariable analysis, top five predictors of cEEG use included seizure diagnosis, hospitals with >500 beds, regions Northeast and South, and anesthetic use. Top predictors of mortality included use of mechanical ventilation, vasopressors, anesthetics, antiseizure medications, and age. Propensity analysis showed that cEEG was associated with lower in-hospital mortality (Average Treatment Effect -0.015 [95% confidence interval -0.028 to -0.003], Odds ratio 0.746 [95% confidence interval, 0.618-0.900]).
There has been a national increase in cEEG utilization for hospitalized patients with cerebrovascular diseases, with practice variation. cEEG utilization was associated with lower in-hospital mortality. Larger comparative studies of cEEG-guided treatments are indicated to inform best practices, guide policy changes for increased access, and create guidelines on triaging and transferring patients to centers with cEEG capability.
对于患有脑血管疾病且疑似癫痫发作或原因不明的神经功能衰退的住院患者，建议进行连续脑电图监测（cEEG）。我们试图（1）确定cEEG使用方面的实践差异领域，（2）确定cEEG使用的预测因素，（3）评估cEEG使用是否与脑血管疾病患者的预后相关。
这项对Premier医疗数据库（2014 - 2020年）的队列研究纳入了年龄大于18岁的患有脑血管疾病（通过ICD编码识别）的住院患者。通过国际疾病分类（ICD）/当前操作术语（CPT）编码识别连续脑电图监测。使用多变量套索逻辑回归来确定cEEG使用和住院死亡率的预测因素。进行倾向评分匹配分析以确定cEEG使用与死亡率之间的关系。
共纳入1,179,471例住院病例；16,777例（1.4%）接受了cEEG检查。cEEG的总数在5年内增加了364%（平均每年32%）。多变量分析显示，cEEG使用的前五个预测因素包括癫痫诊断、床位超过500张的医院、东北部和南部地区以及麻醉剂的使用。死亡率的主要预测因素包括机械通气、血管加压药、麻醉剂、抗癫痫药物的使用以及年龄。倾向分析表明，cEEG与较低的住院死亡率相关（平均治疗效果 -0.015 [95%置信区间 -0.028至 -0.003]，优势比0.746 [95%置信区间，0.618 - 0.900]）。
全国范围内，患有脑血管疾病的住院患者对cEEG的使用有所增加，但存在实践差异。cEEG的使用与较低的住院死亡率相关。需要开展更大规模的cEEG引导治疗的比较研究，以提供最佳实践信息，指导政策变革以增加可及性，并制定关于将患者分诊和转诊至具备cEEG能力的中心的指南。
