Periodic Discharges in Critically Ill Children: Predictors and Outcome.
Publication/Presentation Date
5-1-2024
Abstract
OBJECTIVES: We aimed to identify clinical and EEG monitoring characteristics associated with generalized, lateralized, and bilateral-independent periodic discharges (GPDs, LPDs, and BIPDs) and to determine which patterns were associated with outcomes in critically ill children.
METHODS: We performed a prospective observational study of consecutive critically ill children undergoing continuous EEG monitoring, including standardized scoring of GPDs, LPDs, and BIPDs. We identified variables associated with GPDs, LPDs, and BIPDs and assessed whether each pattern was associated with hospital discharge outcomes including the Glasgow Outcome Scale-Extended Pediatric version (GOS-E-Peds), Pediatric Cerebral Performance Category (PCPC), and mortality.
RESULTS: PDs occurred in 7% (91/1,399) of subjects. Multivariable logistic regression indicated that patients with coma (odds ratio [OR], 3.45; 95% confidence interval [CI]: 1.55, 7.68) and abnormal EEG background category (OR, 6.85; 95% CI: 3.37, 13.94) were at increased risk for GPDs. GPDs were associated with mortality (OR, 3.34; 95% CI: 1.24, 9.02) but not unfavorable GOS-E-Peds (OR, 1.93; 95% CI: 0.88, 4.23) or PCPC (OR, 1.64; 95% CI: 0.75, 3.58). Patients with acute nonstructural encephalopathy did not experience LPDs, and LPDs were not associated with mortality or unfavorable outcomes. BIPDs were associated with mortality (OR, 3.68; 95% CI: 1.14, 11.92), unfavorable GOS-E-Peds (OR, 5.00; 95% CI: 1.39, 18.00), and unfavorable PCPC (OR, 5.96; 95% CI: 1.65, 21.46).
SIGNIFICANCE: Patients with coma or more abnormal EEG background category had an increased risk for GPDs and BIPDs, and no patients with an acute nonstructural encephalopathy experienced LPDs. GPDs were associated with mortality and BIPDs were associated with mortality and unfavorable outcomes, but LPDs were not associated with unfavorable outcomes.
Volume
41
Issue
4
First Page
297
Last Page
304
ISSN
1537-1603
Published In/Presented At
Fung, F. W., Parikh, D. S., Massey, S. L., Fitzgerald, M. P., Vala, L., Donnelly, M., Jacobwitz, M., Kessler, S. K., Xiao, R., Topjian, A. A., & Abend, N. S. (2024). Periodic Discharges in Critically Ill Children: Predictors and Outcome. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society, 41(4), 297–304. https://doi.org/10.1097/WNP.0000000000000986
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
38079254
Department(s)
Department of Pediatrics
Document Type
Article