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Description
BACKGROUND/PURPOSE: Accurate prognostication following pediatric severe traumatic brain injury (sTBI) remains challenging. Adult neuroprognostication guidelines recommend the use of prediction models that have not yet been validated in pediatric patients. We hypothesized certain continuous electroencephalography (cEEG) characteristics would be associated with unfavorable short-term outcome. METHODS: This was an IRB-approved, 7-year retrospective cohort study of children aged 1.5-18 years admitted to our PICU from 01/2018-12/2024 with sTBI and receiving cEEG monitoring per institutional standard management protocol. cEEG patterns (background, sleep architecture, reactivity, and electrographic seizure) during the first 12-hours of monitoring were analyzed for association with unfavorable short-term outcome at PICU discharge, defined as Pediatric Cerebral Performance Category (PCPC) score 4-6. Non-parametric statistical analyses were performed. Significant associations were determined by Chi-square or Fischer Exact analysis. RESULTS: 54 patients met inclusion criteria with a median age of 9.2 years (IQR: 4.6-14.8), median initial GCS score 3 (IQR 3-6), and median Rotterdam head CT score 3 (IQR: 2-5). 33 (61.1%) were male; 12 (22.2%) had suspected clinical seizures; 28 (51.9%) received neurosurgical intervention; and 13 (24.1%) died. Unfavorable outcome at PICU discharge was significantly associated with absence of sleep architecture (OR: 19.0 [95%CI: 4.4-81.6], p< 0.001) and presence of electrographic seizures (OR: undefined [approximated: 15.3], p=0.024) on cEEG. CONCLUSIONS: Absence of sleep architecture and presence of seizures in the first 12-hours of cEEG monitoring are associated with unfavorable short-term outcome. Incorporating these cEEG patterns may enhance future development of improved neuroprognostic models for pediatric sTBI.
Publication Date
9-2025
Disciplines
Critical Care | Neurology | Pediatrics
When and Where Presented
Prsented at the Pediatric Neurocritical Care Research Group (PNCRG) Fall Meeting; Montreal, Quebec; September 18-21, 2025
Recommended Citation
Lu, Xuexin; Hall, Ara; Han, Yong Y.; Burdick, Madeline; Moeded, Avner; Boedefeld, Isabella; Kaufman, Christian; and Wallisch, Jessica S., "Discontinuous or Attenuated Background, Absent Sleep Architecture, Absent Reactivity, and Presence of Subclinical Seizures on Continuous Electroencephalography Are Associated with Unfavorable Short-Term Outcome Following Pediatric Severe Traumatic Brain Injury" (2025). Presentations. 119.
https://scholarlyexchange.childrensmercy.org/presentations/119
