Role of Electroencephalography in the Management of Aneurysmal Subarachnoid Hemorrhage: National Inpatient Sample, 2012-2017.

Abstract

Background: Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition characterized by high morbidity and mortality. Electroencephalography (EEG) is often used in the management of critically ill patients in the intensive care unit (ICU). Its role in the management of aSAH is not well known. The objective of this study is to evaluate the role of EEG in the management of aSAH patients by determining the association between EEG and outcomes and resource utilization.

Methods: The National Inpatient Sample (NIS) 2012 to 2017 was queried for adult patients with aSAH. Patients were classified as having received EEG during the hospitalization or not. The NIS-SAH severity score (NIS-SSS) was used to account for illness severity. Weighted multivariable regression models were used to estimate the association between the use of EEG and outcome of interest (total cost of care, length of stay (LOS), in-hospital mortality, and home discharge) adjusting for demographic, comorbidities, and other clinical characteristics.

Results: Among 41,896 patients with SAH (mean age 61.3 years, 41.8% male), 3.8% received EEG monitoring and had higher NIS-SSS (11.2 vs. 7.3, P <0.001). In multivariable models, the use of EEG was associated with higher cost of care (β=$113,740, 95% CI: $101,109-126,371) and longer LOS (β=6.21, 95% CI: 5.57-6.85). Patients with EEG had significantly lower risk of death in hospital (ARR=0.86, 95% CI: 0.77-0.96) but lower likelihood of home/self-care discharge (ARR=0.79, 95% CI: 0.70-0.89).

Conclusion: EEG monitoring was used in a minority of critically ill patients with aSAH. Although associated with increased cost of care and longer LOS, EEG likely averts adverse outcomes in patients with high severity and improves the chance of survival.