Electrographic Status Epilepticus Is Associated With Mortality and Worse Short-Term Outcome in Critically Ill Children*

Topjian, Alexis; Gutierrez‐Colina, Ana M.; Sánchez, Sarah; Berg, Robert A.; Friess, Stuart H.; Dlugos, Dennis J.; Abend, Nicholas S.

doi:10.1097/ccm.0b013e3182668035

Cited by 176 publications

(221 citation statements)

References 42 publications

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“…15,27 A number of single-center studies have demonstrated an association between electrographic seizures or electrographic status epilepticus and worse outcome in critically ill children. 11,12,14,16,17,28 Our data also indicate that electrographic status epilepticus was associated with higher mortality, even after adjusting for the neurologic diagnosis category and initial EEG background category. However, the current data cannot establish whether electrographic status epilepticus is a modifiable risk factor for mortality or is a nonmodifiable biomarker of severe brain injury leading to mortality.…”

supporting

confidence: 53%

“…Both this study and a prior single-center study reported worse short-term outcome with electrographic status epilepticus but not electrographic seizures. 16 If these data are replicated in studies with long-term outcome measures, then quantitative EEG methods may not need to identify every brief seizure if they can reliably identify a seizure burden that is sufficient to worsen outcome. There has also been interest in the use of more limited electrode montages in order to permit easier electrode application.…”

mentioning

confidence: 99%

“…Data obtained from CEEG reportedly affect clinical management in 59% of monitored children, most often by affecting anticonvulsant utilization. 15 Several studies have reported an association between electrographic seizures or status epilepticus and worse outcome, 11,12,16,17 occurring independently of potential confounders related to acute etiology and critical illness severity.…”

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confidence: 99%

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Electrographic seizures in pediatric ICU patients

et al. 2013

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Objectives: We aimed to determine the incidence of electrographic seizures in children in the pediatric intensive care unit who underwent EEG monitoring, risk factors for electrographic seizures, and whether electrographic seizures were associated with increased odds of mortality.Methods: Eleven sites in North America retrospectively reviewed a total of 550 consecutive children in pediatric intensive care units who underwent EEG monitoring. We collected data on demographics, diagnoses, clinical seizures, mental status at EEG onset, EEG background, interictal epileptiform discharges, electrographic seizures, intensive care unit length of stay, and in-hospital mortality.Results: Electrographic seizures occurred in 162 of 550 subjects (30%), of which 61 subjects (38%) had electrographic status epilepticus. Electrographic seizures were exclusively subclinical in 59 of 162 subjects (36%). A multivariable logistic regression model showed that independent risk factors for electrographic seizures included younger age, clinical seizures prior to EEG monitoring, an abnormal initial EEG background, interictal epileptiform discharges, and a diagnosis of epilepsy. Subjects with electrographic status epilepticus had greater odds of in-hospital death, even after adjusting for EEG background and neurologic diagnosis category.Conclusions: Electrographic seizures are common among children in the pediatric intensive care unit, particularly those with specific risk factors. Electrographic status epilepticus occurs in more than one-third of children with electrographic seizures and is associated with higher in-hospital mortality. Neurology â 2013;81:383-391 GLOSSARY CEEG 5 continuous EEG; CI 5 confidence interval; IQR 5 interquartile range; OR 5 odds ratio; PICU 5 pediatric intensive care unit.

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confidence: 99%

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confidence: 99%

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Electrographic seizures in pediatric ICU patients

et al. 2013

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“…Encountering seizures is common for pediatrics residents working on inpatient wards, 1 and a rotation in pediatric neurology is a requirement of the Accreditation Council for Graduate Medical Education. 2 From our experience, teaching time-sensitive management of potentially lifethreatening conditions, including seizures, remains a challenge.…”

Section: Introductionmentioning

confidence: 99%

“…Ineffective management of seizures in adults can lead to status epilepticus (SE), and potentially worse patient outcomes. 1,3 At our institution, first-year residents (interns) are the primary providers and expected to execute timely management to avoid progression to SE.…”

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confidence: 99%

Mastery of Status Epilepticus Management via Simulation-Based Learning for Pediatrics Residents

Malakooti¹,

McBride²,

Mobley³

et al. 2015

Journal of Graduate Medical Education

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Background Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may be due to ineffective provider education, and can lead to unfavorable outcomes. Objective To design a learning module using high-fidelity simulation technology to teach mastery achievement of a hospital algorithm for managing SE. Methods Thirty pediatrics interns were enrolled. Using the Angoff method, an expert panel developed the minimal passing score, which defined mastery. Scoring of simulated performance was done by 2 observers. Sessions were digitally recorded. After the pretest, participants were debriefed on the algorithm and required to repeat the simulation. If mastery (minimal passing score) was not achieved, debriefing and the simulation were repeated until mastery was met. Once mastery was met, participants graded their comfort level in managing SE. Results No participants achieved mastery at pretest. After debriefing and deliberate simulator training, all (n = 30) achieved mastery of the algorithm: 30% achieved mastery after 1 posttest, 63% after a second, and 6.7% after a third. The Krippendorff α was 0.94, indicating strong interrater agreement. Participants reported more self-efficacy in managing SE, a preference for simulation-based education for learning practice-based algorithms of critical conditions, and highly rated the educational intervention. Conclusions A simulation-based mastery learning program using deliberate practice dramatically improves pediatrics residents' execution of a SE management protocol. Participants enjoyed and benefited from simulation education. Future applications include improving adherence to other hospital protocols.

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Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs

Sutton

Wolfe

Reeder

et al. 2022

JAMA

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IMPORTANCE Approximately 40% of children who experience an in-hospital cardiac arrest survive to hospital discharge. Achieving threshold intra-arrest diastolic blood pressure (BP) targets during cardiopulmonary resuscitation (CPR) and systolic BP targets after the return of circulation may be associated with improved outcomes. OBJECTIVE To evaluate the effectiveness of a bundled intervention comprising physiologically focused CPR training at the point of care and structured clinical event debriefings. DESIGN, SETTING, AND PARTICIPANTSA parallel, hybrid stepped-wedge, cluster randomized trial (Improving Outcomes from Pediatric Cardiac Arrest-the ICU-Resuscitation Project [ICU-RESUS]) involving 18 pediatric intensive care units (ICUs) from 10 clinical sites in the US. In this hybrid trial, 2 clinical sites were randomized to remain in the intervention group and 2 in the control group for the duration of the study, and 6 were randomized to transition from the control condition to the intervention in a stepped-wedge fashion. The index (first) CPR events of 1129 pediatric ICU patients were included between October 1, 2016, and March 31, 2021, and were followed up to hospital discharge (final follow-up was April 30, 2021).INTERVENTION During the intervention period (n = 526 patients), a 2-part ICU resuscitation quality improvement bundle was implemented, consisting of CPR training at the point of care on a manikin (48 trainings/unit per month) and structured physiologically focused debriefings of cardiac arrest events (1 debriefing/unit per month). The control period (n = 548 patients) consisted of usual pediatric ICU management of cardiac arrest. MAIN OUTCOMES AND MEASURESThe primary outcome was survival to hospital discharge with a favorable neurologic outcome defined as a Pediatric Cerebral Performance Category score of 1 to 3 or no change from baseline (score range, 1 [normal] to 6 [brain death or death]). The secondary outcome was survival to hospital discharge. RESULTS Among 1389 cardiac arrests experienced by 1276 patients, 1129 index CPR events (median patient age, 0.6 [IQR, 0.2-3.8] years; 499 girls [44%]) were included and 1074 were analyzed in the primary analysis. There was no significant difference in the primary outcome of survival to hospital discharge with favorable neurologic outcomes in the intervention group (53.8%) vs control (52.4%); risk difference (RD), 3.2% (95% CI, −4.6% to 11.4%); adjusted OR, 1.08 (95% CI, 0.76 to 1.53). There was also no significant difference in survival to hospital discharge in the intervention group (58.0%) vs control group (56.8%); RD, 1.6% (95% CI, −6.2% to 9.7%); adjusted OR, 1.03 (95% CI, 0.73 to 1.47). CONCLUSIONS AND RELEVANCEIn this randomized clinical trial conducted in 18 pediatric intensive care units, a bundled intervention of cardiopulmonary resuscitation training at the point of care and physiologically focused structured debriefing, compared with usual care, did not significantly improve patient survival to hospital discharge with favorable neurologic outco...

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Electrographic Status Epilepticus Is Associated With Mortality and Worse Short-Term Outcome in Critically Ill Children*

Cited by 176 publications

References 42 publications

Electrographic seizures in pediatric ICU patients

Electrographic seizures in pediatric ICU patients

Mastery of Status Epilepticus Management via Simulation-Based Learning for Pediatrics Residents

Effect of Physiologic Point-of-Care Cardiopulmonary Resuscitation Training on Survival With Favorable Neurologic Outcome in Cardiac Arrest in Pediatric ICUs

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