title: Electroencephalography monitoring in critically ill children: current practice and implications for future study design.
abstract: OBJECTIVE
  Survey data indicate that continuous electroencephalography (EEG) (CEEG) monitoring is used with increasing frequency to identify electrographic seizures in critically ill children, but studies of current CEEG practice have not been conducted. We aimed to describe the clinical utilization of CEEG in critically ill children at tertiary care hospitals with a particular focus on variables essential for designing feasible prospective multicenter studies evaluating the impact of electrographic seizures on outcome.
  
  
  METHODS
  Eleven North American centers retrospectively enrolled 550 consecutive critically ill children who underwent CEEG. We collected data regarding subject characteristics, CEEG indications, and CEEG findings.
  
  
  RESULTS
  CEEG indications were encephalopathy with possible seizures in 67% of subjects, event characterization in 38% of subjects, and management of refractory status epilepticus in 11% of subjects. CEEG was initiated outside routine work hours in 47% of subjects. CEEG duration was <12 h in 16%, 12-24 h in 34%, and >24 h in 48%. Substantial variability existed among sites in CEEG indications and neurologic diagnoses, yet within each acute neurologic diagnosis category a similar proportion of subjects at each site had electrographic seizures. Electrographic seizure characteristics including distribution and duration varied across sites and neurologic diagnoses.
  
  
  CONCLUSIONS
  These data provide a systematic assessment of recent CEEG use in critically ill children and indicate variability in practice. The results suggest that multicenter studies are feasible if CEEG monitoring pathways can be standardized. However, the data also indicate that electrographic seizure variability must be considered when designing studies that address the impact of electrographic seizures on outcome.
authors.affiliation: Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, Philadelphia, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Sánchez
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Arndt
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Carpenter
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Chapman
authors.forename: Karen M
authors.initials: KM
authors.lastname: Cornett
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Dlugos
authors.forename: William B
authors.initials: WB
authors.lastname: Gallentine
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Giza
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Goldstein
authors.forename: Cecil D
authors.initials: CD
authors.lastname: Hahn
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lerner
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.forename: Joyce H
authors.initials: JH
authors.lastname: Matsumoto
authors.forename: Kristin
authors.initials: K
authors.lastname: McBain
authors.forename: Kendall B
authors.initials: KB
authors.lastname: Nash
authors.forename: Eric
authors.initials: E
authors.lastname: Payne
authors.forename: Iván
authors.initials: I
authors.lastname: Sánchez Fernández
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
authors.forename: Korwyn
authors.initials: K
authors.lastname: Williams
authors.forename: Amy
authors.initials: A
authors.lastname: Yang
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D016638:Critical Illness; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods* / Q000639:trends*; D009460:Neurologic Examination; D012189:Retrospective Studies; D055815:Young Adult
keywords: EEG monitoring; Nonconvulsive seizure; Pediatric; Seizure; Status epilepticus