title: Electrographic status epilepticus is associated with mortality and worse short-term outcome in critically ill children.
abstract: OBJECTIVE
  Electrographic seizures and electrographic status epilepticus are common in critically ill children. We aimed to determine whether electrographic seizures and electrographic status epilepticus are associated with higher mortality or worse short-term neurologic outcome.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  PICU of a tertiary children's hospital.
  
  
  METHODS
  Non-neonatal children admitted to a PICU with acute encephalopathy underwent continuous electroencephalographic monitoring. Electroencephalographs were scored as 1) no seizures, 2) electrographic seizures, or 3) electrographic status epilepticus. Covariates included age, acute neurologic disorder category, prior neurodevelopmental status, sex, and electroencephalographic background category. Outcomes were mortality and worsening of pediatric cerebral performance category from preadmission to PICU discharge. Chi-square analysis, Fisher's exact test, and multivariable logistic regression were used to evaluate the associations between electrographic seizures or electrographic status epilepticus and mortality or short-term neurologic outcome, using odds ratios and 95% confidence intervals.
  
  
  METHODS
  None.
  
  
  RESULTS
  Two hundred children underwent continuous electroencephalographic monitoring. Eighty-four (42%) had seizures, which were categorized as electrographic seizures in 41 (20.5%) and electrographic status epilepticus in 43 (21.5%). Thirty-six subjects (18%) died, and 88 subjects (44%) had pediatric cerebral performance category worsening. In multivariable analysis, electrographic status epilepticus was associated with an increased risk of mortality (odds ratio 5.1; 95% confidence interval 1.4, 18; p = 0.01) and pediatric cerebral performance category worsening (odds ratio 17.3; 95% confidence interval 3.7, 80; p < 0.001), whereas electrographic seizures were not associated with an increased risk of mortality (odds ratio 1.3; 95% confidence interval 0.3, 5.1; p = 0.74) or pediatric cerebral performance category worsening (odds ratio 1.2; 95% confidence interval 0.4, 3.9; p = 0.77).
  
  
  CONCLUSIONS
  Electrographic status epilepticus, but not electrographic seizures, is associated with mortality and worse short-term neurologic outcome in critically ill children with acute encephalopathy.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Topjian
authors.forename: Ana M
authors.initials: AM
authors.lastname: Gutierrez-Colina
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Sanchez
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Friess
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Dlugos
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
mesh_terms: D001927:Brain Diseases / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012640:Seizures / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality; D013226:Status Epilepticus / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D014481:United States / Q000453:epidemiology