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Effects of epileptiform activity on discharge outcome in critically ill patients in the USA: a retrospective cross-sectional study.

Publication ,  Journal Article
Parikh, H; Hoffman, K; Sun, H; Zafar, SF; Ge, W; Jing, J; Liu, L; Sun, J; Struck, A; Volfovsky, A; Rudin, C; Westover, MB
Published in: The Lancet. Digital health
August 2023

Epileptiform activity is associated with worse patient outcomes, including increased risk of disability and death. However, the effect of epileptiform activity on neurological outcome is confounded by the feedback between treatment with antiseizure medications and epileptiform activity burden. We aimed to quantify the heterogeneous effects of epileptiform activity with an interpretability-centred approach.We did a retrospective, cross-sectional study of patients in the intensive care unit who were admitted to Massachusetts General Hospital (Boston, MA, USA). Participants were aged 18 years or older and had electrographic epileptiform activity identified by a clinical neurophysiologist or epileptologist. The outcome was the dichotomised modified Rankin Scale (mRS) at discharge and the exposure was epileptiform activity burden defined as mean or maximum proportion of time spent with epileptiform activity in 6 h windows in the first 24 h of electroencephalography. We estimated the change in discharge mRS if everyone in the dataset had experienced a specific epileptiform activity burden and were untreated. We combined pharmacological modelling with an interpretable matching method to account for confounding and epileptiform activity-antiseizure medication feedback. The quality of the matched groups was validated by the neurologists.Between Dec 1, 2011, and Oct 14, 2017, 1514 patients were admitted to Massachusetts General Hospital intensive care unit, 995 (66%) of whom were included in the analysis. Compared with patients with a maximum epileptiform activity of 0 to less than 25%, patients with a maximum epileptiform activity burden of 75% or more when untreated had a mean 22·27% (SD 0·92) increased chance of a poor outcome (severe disability or death). Moderate but long-lasting epileptiform activity (mean epileptiform activity burden 2% to <10%) increased the risk of a poor outcome by mean 13·52% (SD 1·93). The effect sizes were heterogeneous depending on preadmission profile-eg, patients with hypoxic-ischaemic encephalopathy or acquired brain injury were more adversely affected compared with patients without these conditions.Our results suggest that interventions should put a higher priority on patients with an average epileptiform activity burden 10% or greater, and treatment should be more conservative when maximum epileptiform activity burden is low. Treatment should also be tailored to individual preadmission profiles because the potential for epileptiform activity to cause harm depends on age, medical history, and reason for admission.National Institutes of Health and National Science Foundation.

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Published In

The Lancet. Digital health

DOI

EISSN

2589-7500

ISSN

2589-7500

Publication Date

August 2023

Volume

5

Issue

8

Start / End Page

e495 / e502

Related Subject Headings

  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Patient Discharge
  • Humans
  • Cross-Sectional Studies
  • Critical Illness
  • 4203 Health services and systems
 

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Parikh, H., Hoffman, K., Sun, H., Zafar, S. F., Ge, W., Jing, J., … Westover, M. B. (2023). Effects of epileptiform activity on discharge outcome in critically ill patients in the USA: a retrospective cross-sectional study. The Lancet. Digital Health, 5(8), e495–e502. https://doi.org/10.1016/s2589-7500(23)00088-2
Parikh, Harsh, Kentaro Hoffman, Haoqi Sun, Sahar F. Zafar, Wendong Ge, Jin Jing, Lin Liu, et al. “Effects of epileptiform activity on discharge outcome in critically ill patients in the USA: a retrospective cross-sectional study.The Lancet. Digital Health 5, no. 8 (August 2023): e495–502. https://doi.org/10.1016/s2589-7500(23)00088-2.
Parikh H, Hoffman K, Sun H, Zafar SF, Ge W, Jing J, et al. Effects of epileptiform activity on discharge outcome in critically ill patients in the USA: a retrospective cross-sectional study. The Lancet Digital health. 2023 Aug;5(8):e495–502.
Parikh, Harsh, et al. “Effects of epileptiform activity on discharge outcome in critically ill patients in the USA: a retrospective cross-sectional study.The Lancet. Digital Health, vol. 5, no. 8, Aug. 2023, pp. e495–502. Epmc, doi:10.1016/s2589-7500(23)00088-2.
Parikh H, Hoffman K, Sun H, Zafar SF, Ge W, Jing J, Liu L, Sun J, Struck A, Volfovsky A, Rudin C, Westover MB. Effects of epileptiform activity on discharge outcome in critically ill patients in the USA: a retrospective cross-sectional study. The Lancet Digital health. 2023 Aug;5(8):e495–e502.
Journal cover image

Published In

The Lancet. Digital health

DOI

EISSN

2589-7500

ISSN

2589-7500

Publication Date

August 2023

Volume

5

Issue

8

Start / End Page

e495 / e502

Related Subject Headings

  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Patient Discharge
  • Humans
  • Cross-Sectional Studies
  • Critical Illness
  • 4203 Health services and systems