L. Aquino1, C. Y. Kang1, M. Y. Harada1, A. Ko1, E. J. Ley1, D. R. Margulies1, R. F. Alban1 1Cedars-Sinai Medical Center,Division Of Trauma And Critical Care,Los Angeles, CA, USA
Introduction: Severe traumatic brain injury (TBI) has been associated with potential increased risk for early clinical and subclinical seizures. The use of continuous electroencephalography monitoring (cEEG) in TBI patients allows for potential identification and subsequent treatment of seizures that may otherwise occur undetected. The benefits of ‘routine’ cEEG after TBI remains controversial. This test is time consuming, utilizes a significant amount of resources and is expensive. To evaluate the benefit of cEEG, we examined the rate of clinical and subclinical seizures identified by cEEG in a cohort of moderate to severe TBI patients admitted to a Level I urban trauma center.
Methods: We analyzed a cohort of trauma patients with moderate to severe TBI (head AIS ≥ 3) who received cEEG within 7 days of admission at our Level I trauma center between October 2011 and May 2015. Demographics, clinical data, injury severity, and costs were recorded. Rate of seizure activity based on cEEG result was analyzed and clinical characteristics were compared between those with and without seizures.
Results: A total of 106 TBI patients with moderate to severe TBI received a routine cEEG during the study period. Most were male (74%) with a mean age of 55.1 ± 23.5 years. Subclinical seizures were identified by cEEG in only 4 (3.8%) of these patients. Of all patients, 93% were on anti-seizure prophylaxis at the time of cEEG. Patients who had subclinical seizures were significantly older than their counterparts (80 v. 54 years, p=0.01) and had a higher mean head AIS (5.0 v. 4.0, p=0.01) and ISS (27 v. 22, p=0.03). Mortality and ICU stay was similar for both groups. In addition, the estimated total direct cost for cEEGs on all patients was $68,488.
Conclusion: Of all TBI patients who were monitored with cEEG, only 3.8% were identified to have seizures. These neurological events were more likely to occur in older patients with severe head injury. Given the high cost of cEEG and the low incidence of subclinical seizures, we do not recommend ‘routine’ cEEG in patients with TBI. Rather, cEEG monitoring in TBI patients should be conducted only when clinically indicated.
