Abstract
Background: The practice of continuous EEG monitoring (CEEG) in the intensive care unit (ICU) has spread over the past decade. Building an effective ICU CEEG program demands adequate EEG equipment and human resources. This may not be available in developing healthcare systems. This study sought to shed light on the real-life utility of CEEG at a tertiary healthcare center in the developing healthcare system of Saudi Arabia,. Methods: This is a retrospective review of CEEG findings, along with mortality and duration of hospitalization of patients who had CEEG during a 12-month period at the adult ICU at the King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Results: A total of 202 CEEG records were identified. A total of 52 patients had non-convulsive seizures (NCS); 10 clearly fulfilled criteria for non-convulsive status epilepticus. There were 120 patients that had clinical seizures upon presentation. Among them, 36 (30%) had NCS on EEG. The proportion of patients who were deceased at 60 days was higher in patients with NCS than those who didn’t have NCS (42% vs 27%, χ2 = 4.4, df=2, p=0.03). The proportion with long hospitalization was higher in those who had periodic or rhythmic CEEG patterns (33.3% vs 28.1%, χ2 = 8.02, df=2, p=0.02) but there was no significant relationship with mortality at 60 days. Conclusion: This study demonstrates a real-world experience from a tertiary care center in Saudi Arabia, a developing healthcare system. Findings are consistent with prior experience that ICU CEEG is effective in detecting potentially harmful subclinical patterns, supporting the need to develop ICU CEEG programs. However, the incurred excesses in morbidity and mortality associated with CEEG patterns were relatively modest. Further studies are needed to delineate how the practice of CEEG may be developed to provide meaningful data to clinicians with regards to patient outcomes.
Highlights
The practice of continuous EEG monitoring (CEEG) in the intensive care unit (ICU) has spread over the past decade
This study reviewed data generated from a CEEG program in the adult ICU at a tertiary healthcare center in Saudi Arabia, aiming to shed light on the real-life utility of CEEG in a developing healthcare system outside North America and Europe
ICU physicians or neurologists request CEEG to search for non-convulsive seizures (NCS) or patterns on the ictal-interictal continuum when critically ill patients have a disturbance in the level of consciousness that is unexplained by apparent underlying neurological or medical conditions
Summary
The practice of continuous EEG monitoring (CEEG) in the intensive care unit (ICU) has spread over the past decade. Building an effective ICU CEEG program demands adequate EEG equipment and human resources. This may not be available in developing healthcare systems. This study sought to shed light on the real-life utility of CEEG at a tertiary healthcare center in the developing healthcare system of Saudi Arabia,. The proportion with long hospitalization was higher in those who had periodic or rhythmic CEEG patterns (33.3% vs 28.1%, χ2 = 8.02, df=2, p=0.02) but there was no significant relationship with mortality at 60 days. Conclusion: This study demonstrates a real-world experience from a tertiary care center in Saudi Arabia, a developing healthcare system. Further studies are needed to delineate how the practice of CEEG may be developed to provide meaningful data to clinicians with regards to patient outcomes
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