title: Development and validation of a seizure prediction model in critically ill children.
abstract: OBJECTIVE
  Electrographic seizures are common in encephalopathic critically ill children, but identification requires continuous EEG monitoring (CEEG). Development of a seizure prediction model would enable more efficient use of limited CEEG resources. We aimed to develop and validate a seizure prediction model for use among encephalopathic critically ill children.
  
  
  METHODS
  We developed a seizure prediction model using a retrospectively acquired multi-center database of children with acute encephalopathy without an epilepsy diagnosis, who underwent clinically indicated CEEG. We performed model validation using a separate prospectively acquired single center database. Predictor variables were chosen to be readily available to clinicians prior to the onset of CEEG and included: age, etiology category, clinical seizures prior to CEEG, initial EEG background category, and inter-ictal discharge category.
  
  
  RESULTS
  The model has fair to good discrimination ability and overall performance. At the optimal cut-off point in the validation dataset, the model has a sensitivity of 59% and a specificity of 81%. Varied cut-off points could be chosen to optimize sensitivity or specificity depending on available CEEG resources.
  
  
  CONCLUSIONS
  Despite inherent variability between centers, a model developed using multi-center CEEG data and few readily available variables could guide the use of limited CEEG resources when applied at a single center. Depending on CEEG resources, centers could choose lower cut-off points to maximize identification of all patients with seizures (but with more patients monitored) or higher cut-off points to reduce resource utilization by reducing monitoring of lower risk patients (but with failure to identify some patients with seizures).
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at The University of Pennsylvania, United States.
authors.forename: Amy
authors.initials: A
authors.lastname: Yang
authors.affiliation: Departments of Pediatrics and Neurology, Beaumont Children's Hospital and Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Arndt
authors.affiliation: Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.affiliation: Department of Neurology, Children's National Medical Center, Washington, DC, United States.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Carpenter
authors.affiliation: Department of Pediatrics and Neurology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Chapman
authors.affiliation: Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Dlugos
authors.affiliation: Division of Neurology, Duke Children's Hospital and Duke University School of Medicine, Durham, NC, United States.
authors.forename: William B
authors.initials: WB
authors.lastname: Gallentine
authors.affiliation: Division of Neurology, Department of Pediatrics Mattel Children's Hospital and UCLA Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Giza
authors.affiliation: Division of Neurology, Children's Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Goldstein
authors.affiliation: Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, ON, United States.
authors.forename: Cecil D
authors.initials: CD
authors.lastname: Hahn
authors.affiliation: Division of Neurology, Department of Pediatrics Mattel Children's Hospital and UCLA Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Lerner
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.affiliation: Division of Neurology, Department of Pediatrics Mattel Children's Hospital and UCLA Brain Injury Research Center, Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
authors.forename: Joyce H
authors.initials: JH
authors.lastname: Matsumoto
authors.affiliation: Department of Neurology, University of California San Francisco, San Francisco, CA, United States.
authors.forename: Kendall B
authors.initials: KB
authors.lastname: Nash
authors.affiliation: Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, ON, United States.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Payne
authors.affiliation: Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States.
authors.forename: Iván
authors.initials: I
authors.lastname: Sánchez Fernández
authors.affiliation: Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at The University of Pennsylvania, United States.
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
authors.affiliation: Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Topjian
authors.affiliation: Department of Pediatrics, University of Arizona College of Medicine and Barrow's Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, United States.
authors.forename: Korwyn
authors.initials: K
authors.lastname: Williams
authors.affiliation: Division of Child Neurology, Stanford University, Palo Alto, CA, United States.
authors.forename: Courtney J
authors.initials: CJ
authors.lastname: Wusthoff
authors.affiliation: Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia and The Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, United States. Electronic address: abend@chop.edu.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
mesh_terms: D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D016208:Databases, Factual; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008959:Models, Neurological; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity
keywords: EEG monitoring; Non-convulsive seizure; Pediatric; Prediction model; Seizure; Status epilepticus