title: Value analysis of continuous EEG in patients during therapeutic hypothermia after cardiac arrest.
abstract: BACKGROUND
  Therapeutic hypothermia (TH) is standard of care after ventricular fibrillation cardiac arrest (CA). Continuous EEG monitoring (cEEG) is increasingly used during TH. Analysis regarding value of cEEG utilization in this population in the context of cost and outcome has not been performed. We compared outcome and EEG charges in CA patients with selective versus routine cEEG.
  
  
  METHODS
  A protocol for TH after CA without routine cEEG was implemented in December 2005, comprising our TH-pre-cEEG cohort. In November 2009, this protocol was changed to include cEEG in all CA-TH patients, comprising our TH-cEEG cohort. Clinical outcome using the Cerebral Performance Category (CPC) at discharge and estimated EEG charges were calculated retrospectively for both cohorts, based on National Charge Data 50th percentile charges expressed in USD per the CMS 2010 Standard Analytical File as reported in Code Correct by MedAssets, Inc.
  
  
  RESULTS
  Our TH-pre-cEEG cohort comprised 91 patients, our TH-cEEG cohort 62. In the TH-pre-cEEG cohort, 19 patients (21%) had rEEGs, 4 (4%) underwent cEEG. The mean estimated EEG charges for the TH-pre-cEEG cohort was $1571.59/patient, and TH-cEEG cohort was $4214.93/patient (p<0.0001). Two patients (2.1%) in the TH-pre-cEEG cohort had seizures, compared to five (8.1%) in the TH-cEEG cohort (p=0.088). There was no difference in mortality or clinical outcome in these cohorts.
  
  
  CONCLUSIONS
  Routine use of cEEG during TH after CA improved seizure detection, but not outcomes. There was a three-fold increase in EEG estimated charges with routine use of cEEG.
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, United States; Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, United States; Division of Epilepsy, Department of Neurology, Mayo Clinic, AZ, United States. Electronic address: Crepeau.amy@mayo.edu.
authors.forename: Amy Z
authors.initials: AZ
authors.lastname: Crepeau
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, United States; Division of Neurocritical Care, Department of Neurology, Mayo Clinic, Rochester, MN, United States.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Fugate
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Neurology, Mayo Clinic, Rochester, MN, United States.
authors.forename: Jay
authors.initials: J
authors.lastname: Mandrekar
authors.affiliation: Division of Cardiovascular Diseases, Department of Anesthesiology, Mayo Clinic, Rochester, MN, United States; Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
authors.forename: Roger D
authors.initials: RD
authors.lastname: White
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, United States; Division of Neurocritical Care, Department of Neurology, Mayo Clinic, Rochester, MN, United States.
authors.forename: Eelco F
authors.initials: EF
authors.lastname: Wijdicks
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, United States; Division of Neurocritical Care, Department of Neurology, Mayo Clinic, Rochester, MN, United States.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, United States; Division of Epilepsy, Department of Neurology, Mayo Clinic, Rochester, MN, United States.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Britton
mesh_terms: D004569:Electroencephalography; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Cardiac arrest; Cost; EEG; Prognosis; Therapeutic hypothermia; Value