Utility of Clinical Features in Identifying Electrographic Seizures in Hospitalized Patients Admitted for Non-Neurological Diagnoses.

Q4 Medicine
Critical care explorations Pub Date : 2024-10-21 eCollection Date: 2024-10-01 DOI:10.1097/CCE.0000000000001168
Carolyn Tsai, Courtney Blodgett, Sunghyun Seo, Rizk Alghorazi, Lang Li, Bahjat Qaqish, William J Powers, Clio Rubinos
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Abstract

Importance: Electrographic seizures (ESz) are seizures without prominent motor activity diagnosed with electroencephalogram and are a common complication in critically ill patients with alterations of consciousness. Previous studies suggested clinical signs, including ocular movement abnormalities, facial/periorbital twitching, or remote seizure risk factors, are sensitive for presence of ESz.

Objectives: To assess the utility of clinical features in identifying ESz in critically ill patients with alterations of consciousness.

Design, setting, and participants: This is a retrospective case-control study of 50 patients admitted to the University of North Carolina (UNC) Medical Center and UNC Rex Hospital. Inpatients older than 18 years old undergoing continuous video electroencephalogram (cEEG) were included. Patients admitted for neurologic diagnoses were excluded. A total of 25 patients with ESz (Sz-EEG) were matched with 25 controls by electroencephalogram duration ± 12 hours (No-Sz-EEG). Elements of patient's history and physical findings previously shown to be sensitive for presence of ESz were collected. Descriptive statistical analyses were used.

Results: Most patients were admitted to medical ICUs (72%; n = 36). There was no difference between groups in clinical findings previously shown to be sensitive for ESz. Positive and negative likelihood ratios for these findings generally fell between 1-2 and 0.5-1, respectively, indicating they are inaccurate predictors for ESz. Patients with ESz had significantly higher mortality (p = 0.012).

Conclusions and relevance: Our matched case-control study showed that in the critically ill patient population hospitalized in tertiary care centers and admitted for non-neurologic primary diagnoses, incidence of ocular movement abnormalities, facial/periorbital twitching, and presence of remote risk factors for seizures had low predictive accuracy for ESz. However, these findings are not generalizable to patients with neurologic diseases or to other practice settings with different levels of access to cEEG. We concluded that in this exploratory analysis of hospitalized critically ill patients with non-neurologic diagnoses, these clinical signs did not reliably stratify risk for ESz on cEEG. However, further prospective studies are needed to better evaluate these conclusions.

临床特征在识别因非神经病学诊断入院的住院病人电图癫痫发作中的实用性。
重要性:脑电图癫痫发作(ESz)是通过脑电图诊断出的无明显运动活动的癫痫发作,是伴有意识改变的危重病人的常见并发症。以往的研究表明,包括眼球运动异常、面部/眶周抽搐或远端癫痫发作危险因素在内的临床症状对是否存在 ESz 很敏感:评估临床特征在识别伴有意识改变的重症患者 ESz 中的作用:这是一项回顾性病例对照研究,研究对象是北卡罗来纳大学(UNC)医学中心和 UNC Rex 医院收治的 50 名患者。研究对象包括接受连续视频脑电图(cEEG)检查的 18 岁以上住院患者。因神经系统诊断入院的患者除外。共有 25 名 ESz 患者(Sz-EEG)与 25 名对照组患者(脑电图持续时间 ± 12 小时)(No-Sz-EEG)进行了配对。研究人员还收集了患者的病史和体格检查结果,这些因素以前曾被证明对 ESz 的存在具有敏感性。采用描述性统计分析:大多数患者入住内科重症监护病房(72%;n = 36)。不同组别之间对 ESz 敏感的临床表现没有差异。这些结果的阳性和阴性似然比一般分别在1-2和0.5-1之间,表明它们对ESz的预测并不准确。ESz患者的死亡率明显更高(p = 0.012):我们的配对病例对照研究表明,在三级医疗中心住院并因非神经病学主要诊断入院的重症患者群体中,眼球运动异常、面部/眶周抽动的发生率以及是否存在癫痫发作的远端危险因素对 ESz 的预测准确性较低。但是,这些发现并不能推广到神经系统疾病患者或其他不同水平的 cEEG 使用环境中。我们的结论是,在对非神经系统疾病的住院重症患者进行的探索性分析中,这些临床体征并不能可靠地对 cEEG 上的 ESz 风险进行分层。不过,还需要进一步的前瞻性研究来更好地评估这些结论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.70
自引率
0.00%
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审稿时长
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