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Association of an Electroencephalography-Based Risk Score With Seizure Probability in Hospitalized Patients.

Publication ,  Journal Article
Struck, AF; Ustun, B; Ruiz, AR; Lee, JW; LaRoche, SM; Hirsch, LJ; Gilmore, EJ; Vlachy, J; Haider, HA; Rudin, C; Westover, MB
Published in: JAMA neurology
December 2017

Continuous electroencephalography (EEG) use in critically ill patients is expanding. There is no validated method to combine risk factors and guide clinicians in assessing seizure risk.To use seizure risk factors from EEG and clinical history to create a simple scoring system associated with the probability of seizures in patients with acute illness.We used a prospective multicenter (Emory University Hospital, Brigham and Women's Hospital, and Yale University Hospital) database containing clinical and electrographic variables on 5427 continuous EEG sessions from eligible patients if they had continuous EEG for clinical indications, excluding epilepsy monitoring unit admissions. We created a scoring system model to estimate seizure risk in acutely ill patients undergoing continuous EEG. The model was built using a new machine learning method (RiskSLIM) that is designed to produce accurate, risk-calibrated scoring systems with a limited number of variables and small integer weights. We validated the accuracy and risk calibration of our model using cross-validation and compared its performance with models built with state-of-the-art logistic regression methods. The database was developed by the Critical Care EEG Research Consortium and used data collected over 3 years. The EEG variables were interpreted using standardized terminology by certified reviewers.All patients had more than 6 hours of uninterrupted EEG recordings.The main outcome was the average risk calibration error.There were 5427 continuous EEGs performed on 4772 participants (2868 men, 49.9%; median age, 61 years) performed at 3 institutions, without further demographic stratification. Our final model, 2HELPS2B, had an area under the curve of 0.819 and average calibration error of 2.7% (95% CI, 2.0%-3.6%). It included 6 variables with the following point assignments: (1) brief (ictal) rhythmic discharges (B[I]RDs) (2 points); (2) presence of lateralized periodic discharges, lateralized rhythmic delta activity, or bilateral independent periodic discharges (1 point); (3) prior seizure (1 point); (4) sporadic epileptiform discharges (1 point); (5) frequency greater than 2.0 Hz for any periodic or rhythmic pattern (1 point); and (6) presence of "plus" features (superimposed, rhythmic, sharp, or fast activity) (1 point). The probable seizure risk of each score was 5% for a score of 0, 12% for a score of 1, 27% for a score of 2, 50% for a score of 3, 73% for a score of 4, 88% for a score of 5, and greater than 95% for a score of 6 or 7.The 2HELPS2B model is a quick accurate tool to aid clinical judgment of the risk of seizures in critically ill patients.

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Published In

JAMA neurology

DOI

EISSN

2168-6157

ISSN

2168-6149

Publication Date

December 2017

Volume

74

Issue

12

Start / End Page

1419 / 1424

Related Subject Headings

  • Seizures
  • Risk Assessment
  • Reproducibility of Results
  • Prospective Studies
  • Monitoring, Physiologic
  • Middle Aged
  • Male
  • Machine Learning
  • Humans
  • Hospitalization
 

Citation

APA
Chicago
ICMJE
MLA
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Struck, A. F., Ustun, B., Ruiz, A. R., Lee, J. W., LaRoche, S. M., Hirsch, L. J., … Westover, M. B. (2017). Association of an Electroencephalography-Based Risk Score With Seizure Probability in Hospitalized Patients. JAMA Neurology, 74(12), 1419–1424. https://doi.org/10.1001/jamaneurol.2017.2459
Struck, Aaron F., Berk Ustun, Andres Rodriguez Ruiz, Jong Woo Lee, Suzette M. LaRoche, Lawrence J. Hirsch, Emily J. Gilmore, et al. “Association of an Electroencephalography-Based Risk Score With Seizure Probability in Hospitalized Patients.JAMA Neurology 74, no. 12 (December 2017): 1419–24. https://doi.org/10.1001/jamaneurol.2017.2459.
Struck AF, Ustun B, Ruiz AR, Lee JW, LaRoche SM, Hirsch LJ, et al. Association of an Electroencephalography-Based Risk Score With Seizure Probability in Hospitalized Patients. JAMA neurology. 2017 Dec;74(12):1419–24.
Struck, Aaron F., et al. “Association of an Electroencephalography-Based Risk Score With Seizure Probability in Hospitalized Patients.JAMA Neurology, vol. 74, no. 12, Dec. 2017, pp. 1419–24. Epmc, doi:10.1001/jamaneurol.2017.2459.
Struck AF, Ustun B, Ruiz AR, Lee JW, LaRoche SM, Hirsch LJ, Gilmore EJ, Vlachy J, Haider HA, Rudin C, Westover MB. Association of an Electroencephalography-Based Risk Score With Seizure Probability in Hospitalized Patients. JAMA neurology. 2017 Dec;74(12):1419–1424.

Published In

JAMA neurology

DOI

EISSN

2168-6157

ISSN

2168-6149

Publication Date

December 2017

Volume

74

Issue

12

Start / End Page

1419 / 1424

Related Subject Headings

  • Seizures
  • Risk Assessment
  • Reproducibility of Results
  • Prospective Studies
  • Monitoring, Physiologic
  • Middle Aged
  • Male
  • Machine Learning
  • Humans
  • Hospitalization