Continuous EEG in a Pediatric Intensive Care Unit: Adherence to Monitoring Criteria and Barriers to Adequate Implementation

Ghossein, Jamie; Alnaji, Fuad; Webster, Richard; Bulusu, Srinivas; Pohl, Daniela

doi:10.1007/s12028-020-01053-8

Cited by 10 publications

(17 citation statements)

References 34 publications

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“…Without tech involvement, these studies are often left unreviewed for hours, 36 which may delay definitive therapeutic intervention. 13 This can impact management of burst suppression, identification of new voltage asymmetries or evolving patterns/seizures, and response to patient safety events.…”

Section: Personnel and Professionalizationmentioning

confidence: 99%

“…The dissemination of these guidelines has a clear impact on cEEG utilization. 13 While the greatest strength of evidence remains for patients with convulsive status epilepticus, the burden of epileptiform discharges and seizures in other conditions also correlates with outcomes at hospital discharge—severe acute ischemic stroke in adults 47 and various other indications in critically ill adults 48 and children, 49 50 for instance. cEEG recordings are frequently deployed in pediatric and neonatal ICUs as well as cardiac and surgical ICUs and any other area such as the emergency department where patients may present with some type of altered consciousness or seizure-like events.…”

Section: Conditions That Warrant Tele-eegmentioning

confidence: 99%

“…5 6 7 The emerging evidence for improving patient outcomes with cEEG 4 8 9 10 11 12 and attendant expansion of critical care as well as growing interest in aEEG as an adjunct or alternative to specialized epilepsy centers has propelled widespread dissemination of professional society guidelines that standardize tele-EEG. 13 14 15 16 17 18 19 20 These factors, buttressed by investment in broadband infrastructure and the Current Procedural Terminology (CPT) billing code revisions, particularly post-COVID-19, have facilitated the use and expansion of tele-EEG.…”

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confidence: 99%

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The Past, Present, and Future of Tele-EEG

Murphey¹,

Anderson²

2022

Semin Neurol

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Tele-electroencephalogram (EEG) has become more pervasive over the last 20 years due to advances in technology, both independent of and driven by personnel shortages. The professionalization of EEG services has both limited growth and controlled the quality of tele-EEG. Growing data on the conditions that benefit from brain monitoring have informed increased critical care EEG and ambulatory EEG utilization. Guidelines that marshal responsible use of still-limited resources and changes in broadband and billing practices have also shaped the tele-EEG landscape. It is helpful to characterize the drivers of tele-EEG to navigate barriers to sustainable growth and to build dynamic systems that anticipate challenges in any of the domains that expand access and enhance quality of these diagnostic services. We explore the historical factors and current trends in tele-EEG in the United States in this review.

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Section: Personnel and Professionalizationmentioning

confidence: 99%

Section: Conditions That Warrant Tele-eegmentioning

confidence: 99%

mentioning

confidence: 99%

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The Past, Present, and Future of Tele-EEG

Murphey¹,

Anderson²

2022

Semin Neurol

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“…In recent years, the use of amplitude-integrated EEG (aEEG) has expanded from neonatology into pediatric intensive care, driven by the need for continuous neurophysiological monitoring and the advantages of aEEG as an affordable, broadly available, and easy-to-interpret bedside technique (1). Continuous full channel EEG, the gold standard to monitor electrocortical acitivity in critically ill children, is a scarce resource with high barriers for implementation (2). As an alternative, aEEG has proven useful for the assessment of seizures and guiding antiepileptic treatment in critically ill children, making it the preferred tool by pediatric intensive care givers (1,(3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

The impact of age and electrode position on amplitude-integrated EEGs in children from 1 month to 17 years of age

et al. 2022

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AimAmplitude-integrated electroencephalography (aEEG) is used to monitor electrocortical activity in critically ill children but age-specific reference values are lacking. We aimed to assess the impact of age and electrode position on aEEG amplitudes and derive normal values for pediatric aEEGs from neurologically healthy children.MethodsNormal EEGs from awake children aged 1 month to 17 years (213 female, 237 male) without neurological disease or neuroactive medication were retrospectively converted into aEEGs. Two observers manually measured the upper and lower amplitude borders of the C3 – P3, C4 – P4, C3 – C4, P3 – P4, and Fp1 – Fp2 channels of the 10–20 system. Percentiles (10th, 25th, 50th, 75th, 90th) were calculated for each age group (<1 year, 1 year, 2–5 years, 6–9 years, 10–13 years, 14–17 years).ResultsAmplitude heights and curves differed between channels without sex-specific differences. During the first 2 years of life, upper and lower amplitudes of all but the Fp1–Fp2 channel increased and then declined until 17 years. The decline of the upper Fp1–Fp2 amplitude began at 4 years, while the lower amplitude declined from the 1st year of life.ConclusionsaEEG interpretation must account for age and electrode positions but not for sex in infants and children.

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“…However, adherence to these recommendations remains a significant challenge in the PICU due to access and availability barriers such as lack of cEEG pathways, need for prior neurology approval, and personnel constraints (10)(11)(12). Additionally, general pediatric critical care providers may be less familiar with the indications for cEEG monitoring (10). Together, these factors may contribute to the low cEEG utilization and the prolonged interval between PICU admission and cEEG initiation (10,13,14).…”

mentioning

confidence: 99%

Implementation of a Pediatric Neurocritical Care Program for Children With Status Epilepticus: Adherence to Continuous Electroencephalogram Monitoring

Herman

Nguyen

Chan

et al. 2022

Pediatric Critical Care Medicine

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To describe adherence to continuous electroencephalogram (cEEG) monitoring as part of a pediatric neurocritical care (PNCC) program for status epilepticus (SE). DESIGN:Retrospective review of pre-and postintervention cohorts. SETTING:A pediatric referral hospital. PATIENTS:Children admitted to the PICU for SE. INTERVENTIONS:We restructured the care delivery model to include a pediatric neurointensive care unit (neuro-ICU) and expanded the cEEG capacity. We created a criteria-based cEEG pathway. We provided education to all providers including the nursing staff. MEASUREMENTS AND MAIN RESULTS:The main outcomes were: 1) the percentages of children meeting American Clinical Neurophysiology Society (ACNS) criteria who underwent cEEG monitoring and 2) the time interval between PICU arrival and cEEG initiation. PICU admissions with the diagnosis of SE from May 2017 to December 2017 served as the baseline, which was compared with the same periods in 2018 to 2020 (PNCC era). There were 60 admissions in the pre-PNCC period (2017), 111 in 2018, 118 in 2019, and 108 in 2020. The percentages of admissions from each period that met ACNS criteria for cEEG monitoring were between 84% and 97%. In the pre-PNCC era, 22 of 52 (42%) admissions meeting ACNS criteria underwent cEEG monitoring. In the PNCC era, greater than or equal to 80% of the qualified admissions underwent cEEG monitoring (74/93 [80%] in 2018, 94/115 [82%] in 2019, and 87/101 [86%] in 2020). Compared with the pre-PNCC era, the neuro-ICU had a shorter interval between PICU arrival and cEEG initiation (216 min [141-1,444 min] vs 138 min [103-211 min]). CONCLUSIONS:The implementation of a PNCC program with initiatives in care delivery, allocation of resources, and education was associated with increased adherence to best care practices for the management of SE.

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Continuous EEG in a Pediatric Intensive Care Unit: Adherence to Monitoring Criteria and Barriers to Adequate Implementation

Cited by 10 publications

References 34 publications

The Past, Present, and Future of Tele-EEG

The Past, Present, and Future of Tele-EEG

The impact of age and electrode position on amplitude-integrated EEGs in children from 1 month to 17 years of age

Implementation of a Pediatric Neurocritical Care Program for Children With Status Epilepticus: Adherence to Continuous Electroencephalogram Monitoring

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