Continuous Versus Routine EEG in Critically Ill Patients Without Primary Neurologic Condition: Analysis of a Randomized Controlled Trial

Abstract

Introduction

Continuous EEG (cEEG) is increasingly used in critically ill patients, driven by its superior seizure detection sensitivity over routine EEG (rEEG). However, cEEG is resource-demanding, and whether its use translates into improved clinical outcomes in patients without primary neurologic conditions remains unknown.

Methods

This is a post hoc analysis of the multicenter randomized CERTA trial, in which critically-ill adults were randomized 1:1 to cEEG or two rEEG recordings. Six-month mortality represented the primary outcome, while exploratory outcomes included functional outcome (Cerebral Performance Categories, CPC), detection of seizures/status epilepticus, ictal–interictal continuum features, medication changes, and infections within 4 weeks. Analysis was restricted to patients without primary neurologic injury.

Results

Among 364 enrolled patients, 76 lacked a primary neurologic condition (cEEG: n = 34, rEEG: n = 42). Continuous EEG was not associated with mortality (p = 0.970) or functional outcome (CPC 1–2; p = 0.893). No seizures or status epilepticus were detected in either group. Rates of EEG periodic patterns, ictal–interictal continuum features, medication changes, and infections were comparable between groups.

Conclusion

In critically ill adults without a primary neurologic condition, cEEG was not associated with measurable benefits in survival, neurological recovery, or epileptiform activity detection compared with repeated rEEG, in a cohort without detected electrographic seizures or status epilepticus. Pending larger, ideally prospective comparative studies, repeated routine EEG may represent a reasonable alternative in resource-limited settings.