Continuous Electroencephalography After Moderate to Severe Traumatic Brain Injury
Continuous Electroencephalography After Moderate to Severe Traumatic Brain Injury
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DOI：
10.1097/ccm.0000000000003639
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发表时间：
2019-04-01
影响因子：
8.8
通讯作者：
Foreman, Brandon
中科院分区：
文献类型：
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作者：
Lee, Hyunjo;Mizrahi, Moshe A.;Foreman, Brandon
目的：脑外伤后，连续脑电图被广泛用于检测脑电图癫痫发作。随着标准化的连续脑电图术语的发展，我们的目的是描述发病率和负担的发作-发作间期模式，包括脑电图癫痫发作后中度至重度创伤性脑损伤和相关的连续脑电图功能与functionaloutcome.Design：事后分析的前瞻性，随机对照2期多中心INTREPID 2566研究（临床试验。gov：NCT 00805818）。在进入ICU后开始连续脑电图检查。主要结局为3个月格拉斯哥结局量表扩展版。共识脑电图审查由经认证的标准化连续脑电图术语评估员进行，对临床数据不知情。节律性、周期性或发作模式被称为“发作-发作间期连续体”;严重发作-发作间期连续体被定义为大于或等于1.5 Hz的偏侧节律性δ活动或全身性周期性放电和任何偏侧周期性放电或电图癫痫发作。非穿透性创伤性脑损伤和复苏后格拉斯哥昏迷量表评分为4-12的患者包括在内。干预：无。测量和主要结果：在152例连续脑电图检查的患者中（年龄34 ± 14岁; 88%为男性），22例（14%）有严重的发作-发作间期连续体，其中4例（2.6%）有电描记癫痫发作。严重的发作-发作间期连续负荷与初始预后评分相关，包括创伤性脑损伤临床试验预后和分析国际使命（r = 0.51; p = 0.01）和损伤严重程度评分（r = 0.49; p = 0.01），但与功能结局无关。在控制了临床协变量后，不良结局与后优势心律缺失独立相关（常见比值比，3.38; 95% CI，1.30-9.09），无N2睡眠瞬变（3.69; 1.69-8.20），三角洲活动占优势（2.82; 1.32-6.10）和不连续背景（5.33; 2.28-12.96）。结论：重度发作-发作间期连续模式，包括电描记癫痫发作，与损伤严重程度的临床标志物相关，但与中重度创伤性脑损伤患者的功能结局无关。重要的是，连续脑电图背景特征与功能结果独立相关，并改善了现有经验证的预测模型的曲线下面积。
Objectives: After traumatic brain injury, continuous electroencephalography is widely used to detect electrographic seizures. With the development of standardized continuous electroencephalography terminology, we aimed to describe the prevalence and burden of ictal-interictal patterns, including electrographic seizures after moderate-to-severe traumatic brain injury and to correlate continuous electroencephalography features with functional outcome.Design: Post hoc analysis of the prospective, randomized controlled phase 2 multicenter INTREPID2566 study (ClinicalTrials. gov: NCT00805818). Continuous electroencephalography was initiated upon admission to the ICU. The primary outcome was the 3-month Glasgow Outcome Scale-Extended. Consensus electroencephalography reviews were performed by raters certified in standardized continuous electroencephalography terminology blinded to clinical data. Rhythmic, periodic, or ictal patterns were referred to as " ictal-interictal continuum"; severe ictal-interictal continuum was defined as greater than or equal to 1.5 Hz lateralized rhythmic delta activity or generalized periodic discharges and any lateralized periodic discharges or electrographic seizures.Setting: Twenty U.S. level I trauma centers.Patients: Patients with nonpenetrating traumatic brain injury and postresuscitation Glasgow Coma Scale score of 4-12 were included.Interventions: None.Measurements and Main Results: Among 152 patients with continuous electroencephalography (age 34 +/- 14 yr; 88% male), 22 (14%) had severe ictal-interictal continuum including electrographic seizures in four (2.6%). Severe ictal-interictal continuum burden correlated with initial prognostic scores, including the International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (r = 0.51; p = 0.01) and Injury Severity Score (r = 0.49; p = 0.01), but not with functional outcome. After controlling clinical covariates, unfavorable outcome was independently associated with absence of posterior dominant rhythm (common odds ratio, 3.38; 95% CI, 1.30-9.09), absence of N2 sleep transients (3.69; 1.69-8.20), predominant delta activity (2.82; 1.32-6.10), and discontinuous background (5.33; 2.28-12.96) within the first 72 hours of monitoring.Conclusions: Severe ictal-interictal continuum patterns, including electrographic seizures, were associated with clinical markers of injury severity but not functional outcome in this prospective cohort of patients with moderate-to-severe traumatic brain injury. Importantly, continuous electroencephalography background features were independently associated with functional outcome and improved the area under the curve of existing, validated predictive models.