Prescription patterns for routine EEG ordering in patients with intracranial hemorrhage admitted to a neurointensive care unit

• Published in: Journal of critical care Vol. 50; pp. 262 - 268
• Main Authors: Ghasemi, Mehdi, Azeem, Muhammad Umer, Muehlschlegel, Susanne, Chu, Felicia, Henninger, Nils
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2019; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Alcohol; Blood pressure; Cardiac arrhythmia; Cardiovascular disease; Clinical decision making; Coma; Consensus recommendations; Convulsions & seizures; Coronary vessels; Critical Care; Decision making; Diabetes; Electroencephalography; Electroencephalography (EEG); Electroencephalography - statistics & numerical data; Female; Guideline adherence; Guidelines as Topic; Hemorrhage; Hospitalization; Humans; Hypertension; Intracerebral hemorrhage (ICH); Intracranial Hemorrhages - diagnostic imaging; Middle Aged; Mortality; NMR; Nuclear magnetic resonance; Patient compliance; Patients; Physicians; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies; Seizure; Stroke; Traumatic brain injury; MRI; STROBE; cEEG; LPDs; ASD; Electroencephalography (EEG); Seizure; BIPDs; Guideline adherence; CMO; EEG; AMS; CAD; Clinical decision-making; ICH; CT; PAD; ESICM; GCS; Intracerebral hemorrhage (ICH); neuroICU; ACNS; GPDs; AHA; SAH; Consensus recommendations
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2019.01.006

To examine clinical factors, including established electroencephalography (EEG) consensus recommendations, that may influence EEG-prescription in critically-ill intracerebral hemorrhage (ICH) patients in the neurointensive care unit. Retrospective analysis of 330 ICH patients admitted to a neurointensive care unit at an academic medical center between 01/2013–12/2015. We compared EEG prescription patterns with current EEG consensus recommendations, and employed univariate and multivariable logistic regression modeling to determine clinical variables associated with EEG ordering. Seventy-eight (41%) of 190 subjects underwent EEG in accordance with EEG-consensus guidelines, demonstrating an overall accuracy (probability that EEG prescription aligned with EEG consensus recommendations) of 64.6% (95%-CI59.1–69.7). Factors independently associated with EEG ordering included fulfillment of EEG consensus recommendations, lower admission Glasgow Coma Scale (GCS), and presence of clinical seizures. The unadjusted and adjusted C-statistics for fulfillment of consensus recommendations was 0.74 (95%-CI 0.69–0.80) and 0.85 (95%-CI 0.81–0.90), respectively. Among 83 subjects undergoing EEG (25.2%), EEG findings informed clinical decision-making in 50 patients (60%). EEG appeared underused in ICH, since <50% of patients who fulfilled guideline criteria underwent EEG. Prescription of EEG was related to factors beyond those included in consensus recommendations. Validation of our findings and their association with outcome is required. •Electroencephalography (EEG) appears underused in intracranial hemorrhage (ICH) patients in the neurointensive care unit.•83/330 ICH patients had EEG, and informed clinical decision making in 50.•Only 41% (n = 78) of subjects that fulfilled EEG criteria ultimately underwent EEG.•Fulfillment of EEG recommendations, Glasgow Coma scale score, and clinical seizure were related to EEG.•Physicians' decision to order EEG is related to other, unknown factors beyond current recommendations.