Electroencephalogram Monitoring in Critically Ill Children: Indications and Strategies

Continuous electroencephalographic monitoring often detects nonconvulsive seizures in critically ill children, but it is resource-intense and has not been demonstrated to improve outcomes. As institutions develop clinical pathways for monitoring, they should consider how seemingly minor variations may exert substantial impacts on resource utilization and cost. In our 1-month prospective observational study, each patient in a 45-bed pediatric intensive care unit was screened for potential monitoring indications. We screened 247 patients. Minor differences in monitoring indications would exert substantial impact on resource utilization. We then calculated the number of monitoring days required each month, based on two strategies that differed in monitoring duration. The prolonged-targeted and brief-targeted strategies would have required 106 and 33 monitoring days, respectively. Based on nonconvulsive seizure occurrence data, these strategies would detect 0.14, and 0.43 patients with seizures per monitoring day performed, respectively. A brief-targeted strategy provides a high yield for nonconvulsive seizure identification, but would fail to diagnose some patients with seizures.