Impact of an ICU EEG monitoring pathway on timeliness of therapeutic intervention and electrographic seizure termination.

Abstract

We aimed to determine whether implementation of a structured multidisciplinary electroencephalography (EEG) monitoring pathway improved the timeliness of administration of antiseizure medication in response to electrographic seizures in encephalopathic critically ill children. A multidisciplinary team developed a pathway to standardize EEG monitoring and seizure management in encephalopathic critically ill children, aiming to decrease the time from electrographic seizure onset to antiseizure medication administration. Data were collected to inform the team of improvement opportunities, which were then provided by an institutional pathway, staff education, and streamlined communication. Measurements were obtained before and after pathway implementation to assess for improvement. We collected data on 41 patients before and 21 after pathway implementation. There were no differences between the baseline and pathway groups in demographic characteristics, acute encephalopathy etiologies, or antiseizure medications utilized. The median duration [interquartile range, IQR] from seizure onset to antiseizure medication administration was shorter for patients treated with the pathway (64min [50, 101]) compared to patients treated prior to pathway implementation (139min [71, 189]; p=0.0006). The median [IQR] interval from seizure onset to antiseizure medication order was shorter for the pathway group (31min [20, 49]) than the baseline group (71min [33, 131]; p=0.003). The median [IQR] interval from antiseizure medication order to administration was shorter for the pathway group (30min [19, 40]) than the baseline group (40min [17, 68]) (p=0.047). Seizure termination was more likely to occur following initial antiseizure medication administration in the pathway than baseline group (67% vs. 27%, p=0.002). Implementation of the pathway resulted in a significant reduction in the duration between electrographic seizure onset and antiseizure medication administration, and a significant increase in the rate of electrographic seizure termination following an initial antiseizure medication. Further study is needed to determine whether these changes are associated with improved outcomes.