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(Abst. 1.078), 2017

Gaps and Opportunities in EEG Monitoring for Pediatric Refractory Status Epilepticus (the pSERG cohort)
Authors: Dmitry Tchapyjnikov, Duke University Medical Center, Duke University. Durham, NC, United States; Feinstein Lydia, University of North Carolina at Chapel Hill, Social and Scientific Systems, Inc.; Marina Gaínza-Lein, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, United States; Universidad Austral de Chile, Valdivia, Chile; Nicholas S. Abend, The Children’s Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania. Philadelphia, PA, United States; Ravindra Arya, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States; J. Nicholas Brenton, University of Virginia Health System, Charlottesville, VA, United States.; Jessica L. Carpenter, Children’s National Medical Center, George Washington University School of Medicine and Health Sciences. Washington, DC, United States; Kevin Chapman, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, United States; William D. Gaillard, Children’s National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.; Tracy A. Glauser, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States; Joshua L. Goldstein, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Howard P. Goodkin, University of Virginia Health System, Charlottesville, VA, United States; Tiffani L. McDonough, Columbia University Medical Center, Columbia University. New York, NY, United States.; Anuranjita Nayak, Baylor College of Medicine. Houston, TX, United States.; Katrina Peariso, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States; James Riviello, Columbia University Medical Center, Columbia University, New York City, NY, United States.; Iván Sánchez Fernández, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, United States;Hospital Sant Joan de Déu, Universidad de Barcelona, Barcelona, Spain; Robert C. Tasker, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, United States; Alexis Topjian, The Children’s Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Mark S. Wainwright, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Korwyn Williams, Barrow Neurological Institute, Phoenix Children’s Hospital, University of Arizona School of Medicine, Phoenix, AZ, United States; Angus Wilfong, Barrow Neurological Institute, Phoenix Children’s Hospital; Tobias Loddenkemper, Boston Children’s Hospital, Harvard University Medical School, Boston, MA, USA; and Mohamad A. Mikati, Duke University Medical Center, Duke University, Durham, NC, United States
Content: Rationale: EEG monitoring is indicated for all children presenting in refractory status epilepticus (RSE) and rapid EEG lead placement is recommended. We assessed the variability in the initiation of continuous EEG monitoring in clinical practice and evaluated factors associated with delays in initiation. Methods: We analyzed data from the Pediatric Status Epilepticus Research Group (pSERG), a multicenter prospective observational cohort of pediatric patients admitted between 2011-2017 with RSE (seizure persisted after ≥2 anti-seizure medications). We used the Kaplan-Meier survival function estimator to non-parametrically calculate the 24-hour cumulative probability of continuous EEG initiation after arrival to a pSERG study hospital. To identify predictors of delayed EEG placement, we used Cox proportional hazards regression to examine whether the 24-hour hazard of continuous EEG initiation following study hospital arrival differed by the following baseline patient characteristics: age, race/ethnicity, gender, weight, type of RSE (intermittent v continuous), neurological history, use of a home anti-seizure medication, and presumed RSE etiology. Results: 207 patients presenting with RSE were included in the analysis. The median time from seizure onset to hospital arrival was 1.8 hours (IQR: 0-4.5). 172 (83%) underwent continuous EEG monitoring and 35 (17%) never had an EEG placed. The median time to EEG placement was 8 hours, with only 10 (6%) patients initiating EEG monitoring within the first hour of hospital arrival and 143 (69%) within the first 24 hours. Use of a home anti-seizure medication was predictive of having delayed EEG initiation (HR 0.69, 95% CI: 0.49-0.95, p=0.02). Among the 172 patients for whom continuous EEG was initiated, 65/172 (38%) were still having seizures at the time of continuous EEG initiation. Predictors of still being in RSE at time of EEG placement were having intermittent rather than continuous RSE (78% v 61%, p=0.02) as well as having the following RSE etiologies: acute symptomatic (22% v 10%, p=0.04) and CNS infection (15% v 4%, p=0.01). Having a remote symptomatic RSE etiology was predictive of RSE resolution prior to continuous EEG initiation (8% v 21%, p=0.02). Conclusions: The time to continuous EEG initiation is delayed in most cases of pediatric RSE, with over a quarter of patients not having an EEG placed within 24 hours of arrival to a study hospital. The use of a home anti-seizure medication is associated with a longer time to continuous EEG initiation. Further studies are warranted to assess how timing of continuous EEG initiation affects treatment plans, seizure control, and patient outcomes. (Supported by Pediatric Epilepsy Research Foundation and Epilepsy Research Fund) Funding: (Supported by Pediatric Epilepsy Research Foundation and Epilepsy Research Fund)
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