Ch 28 (s28.9, s28.14)
An unexplained tachycardia, blood pressure swing or desaturation on its own is a poor reason to record. Combined with gaze deviation, abnormal limb movements or a change in mental status it is a strong one. Supports recording electroencephalography on indication rather than routinely on ECMO.
Seizure yield by indication category
DOI 10.1111/epi.18253
Continuous electroencephalography, with indications categorised as index symptoms of concern (vital-sign or non-vital-sign) and/or clinical risk factors
Paediatric and neonatal cardiovascular intensive care, not adult ECMO — the indication logic transfers but the numbers do not. Single centre, retrospective; does not establish the risk of electrographic seizures by individual clinical risk factor.
Seizures detected in 57 of 605 (9 percent) overall. Zero of 104 studies (0 percent) requested for isolated vital-sign changes detected a seizure (p under 0.001), versus 10 of 101 (10 percent) for non-vital-sign symptoms, 34 of 356 (10 percent) for risk factors alone, and 13 of 44 (30 percent) when vital-sign changes were combined with other symptoms — odds ratio 4.93 (2.45 to 9.77) against risk factors alone. Venoarterial ECMO as an indication yielded seizures in 14 of 116 (12 percent) and extracorporeal cardiopulmonary resuscitation in 8 of 47 (17 percent).
605 consecutive continuous video-electroencephalography studies in 411 patients aged 21 years or younger in one paediatric and neonatal cardiovascular intensive care unit over 38 months; median study duration 26 hours (IQR 20 to 41)