Clinical neurology and neurosurgery · 2026
Continuous electroencephalogram use in pediatric patients with severe traumatic brain injury: Associations with clinical outcomes, predictors of seizure activity, and a retrospective propensity score analysis.
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Wells Russell G, McIntyre Matthew K, Gerges Christina, Rae Ali, Winer Jesse
Аннотация
OBJECTIVE: Continuous scalp electroencephalogram (cEEG) is frequently utilized for patients with severe traumatic brain injury (sTBI, GCS<8 at any point with evidence of intracranial injury); however, the clinical utility of this assessment is unclear. The goal of this study is to evaluate the diagnostic yield, utilization patterns, and associated clinical impact of cEEG on ventilator days and hospital length of stay. We hypothesized that cEEG has a low diagnostic yield in this patient population and may be associated with increased length of stay.
METHODS: Retrospective chart review was performed on patients < 18 years old who presented to Oregon Health and Science University for sTBI from 2016 to 2022. Primary endpoints were use of cEEG and positive cEEG showing seizure. Other endpoints of interest included ventilator days and hospital length of stay. 1:1 propensity score matching for age, GCS, and Rotterdam score was performed to examine endpoints.
RESULTS: 151 patients with sTBI were included, of whom 97 (64.2%) were male with a mean age of 8.8 ± 6.1 years. Patients who underwent cEEG (n = 60) were more severely injured, as evidenced by lower arrival GCS scores (6 vs. 7; p = 0.018), higher Injury Severity Scores (30.2 vs. 25.9; p = 0.023), greater frequency of subdural hematomas (83.3% vs. 56.0%; p < 0.001) and stroke (35.0% vs. 15.4%; p = 0.006). Those who required cEEG had worse clinical outcomes, increased rates of surgical intervention, ventilator days, and hospital length-of-stay. Among those who received cEEG, 5 (9.3%) had seizure activity, with 3/5 of these patients having a clinical seizure prior to arrival. Those with a positive cEEG were significantly younger than those with a negative cEEG (mean 20.6 vs 111.2 months; p < 0.001), all had subdural hematomas and stroke, and most (4/5) were infants (<12 months) with a history of possible abuse or assault. Patients who received cEEG had 4.8 more mechanical ventilator days (95% CI 3.2-6.4 days, p < 0.001) and 11.3 more hospital days (95% CI 6.2-16.4 days, p < 0.001) than propensity-matched patients who did not undergo cEEG.
CONCLUSIONS: Pediatric patients with sTBI who undergo cEEG present with more severe injuries that are associated with worse clinical outcomes. cEEG was found to have a low diagnostic yield, and its routine use may be associated with longer ventilator and hospital days.
METHODS: Retrospective chart review was performed on patients < 18 years old who presented to Oregon Health and Science University for sTBI from 2016 to 2022. Primary endpoints were use of cEEG and positive cEEG showing seizure. Other endpoints of interest included ventilator days and hospital length of stay. 1:1 propensity score matching for age, GCS, and Rotterdam score was performed to examine endpoints.
RESULTS: 151 patients with sTBI were included, of whom 97 (64.2%) were male with a mean age of 8.8 ± 6.1 years. Patients who underwent cEEG (n = 60) were more severely injured, as evidenced by lower arrival GCS scores (6 vs. 7; p = 0.018), higher Injury Severity Scores (30.2 vs. 25.9; p = 0.023), greater frequency of subdural hematomas (83.3% vs. 56.0%; p < 0.001) and stroke (35.0% vs. 15.4%; p = 0.006). Those who required cEEG had worse clinical outcomes, increased rates of surgical intervention, ventilator days, and hospital length-of-stay. Among those who received cEEG, 5 (9.3%) had seizure activity, with 3/5 of these patients having a clinical seizure prior to arrival. Those with a positive cEEG were significantly younger than those with a negative cEEG (mean 20.6 vs 111.2 months; p < 0.001), all had subdural hematomas and stroke, and most (4/5) were infants (<12 months) with a history of possible abuse or assault. Patients who received cEEG had 4.8 more mechanical ventilator days (95% CI 3.2-6.4 days, p < 0.001) and 11.3 more hospital days (95% CI 6.2-16.4 days, p < 0.001) than propensity-matched patients who did not undergo cEEG.
CONCLUSIONS: Pediatric patients with sTBI who undergo cEEG present with more severe injuries that are associated with worse clinical outcomes. cEEG was found to have a low diagnostic yield, and its routine use may be associated with longer ventilator and hospital days.