P.024 Stimulus-Induced Rhythmic, Periodic or Ictal Discharges (SIRPIDs): associated factors and prognostic implications

Abstract

Background: SIRPIDS were first described in 2004 in patients admitted in an intensive care unit. Despite few studies attempting to better characterize SIRPIDS, their pathophysiology and clinical implication remain uncertain. Methods: Adult patients hospitalized in an intensive care unit with alteration of consciousness who underwent EEG recording in three separate centers were included in this retrospective study. Demographic data and EEG findings were noted. Characteristics of SIRPIDS were documented. The main outcome measures included the incidence of SIRPIDS, association of SIRPIDS with mortality and other EEG characteristics, EEG and clinical predictors of mortality. Results: 416 patients were included and SIRPIDs were identified in 43 patients (10.3%). The proportion of patients with SIRPIDs was not significantly different across the three sites (p=0.3351). Anoxia (p=0.0009), antiepileptic medications (p=0.0109), electrographic seizures (p=0.0259), triphasic waves (p=0.0012) and epileptiform discharges (p=0.0242) were independently associated with the presence of SIRPIDs. Older age (p=0.0050), anoxia (p=<0.0001) and absence of EEG reactivity (p<0.0001), but not SIRPIDs (p=0.1668), were independently associated with in-hospital mortality. Conclusions: In critically ill patients undergoing EEG, SIRPIDs occurred in 10% and were associated with other electrographic abnormalities previously reported to indicate poor prognosis. SIRPIDs were not independently associated with in-hospital mortality.