Abstract Details

Title Reliability of EEG Reactivity in the Assessment of Comatose Patients Under Standardized Protocol

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) P14 - Poster Session 14 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-009

Objective To test the use of a standardized protocol for introducing afferent stimuli during electroencephalography (EEG) testing in critically ill comatose patients in the intensive care unit (ICU).

Background EEG provides clinical information about the state of comatose patients through the analysis of background rhythms and epileptiform discharges. This can also provide prognostic information, which can be augmented with the introduction of afferent stimuli and an analysis of changes in background rhythms associated with those stimuli. However, reactivity testing is not standardized and, thus, is often done non-uniformly between and within institutions.

Design/Methods A standardized reactivity protocol was implemented at London Health Sciences Centre. Specific stimuli (calling name, clap, nasal tickle, central pain, and central stimulation) were introduced at specific time-points during routine clinical EEG testing on comatose patients in the ICU. In this retrospective observational study, the first 50 sequential EEGs after implementation were reviewed with REB approval by 2 electroencephalographers and compared with clinical outcome. Inter-rater reliability was assessed.

Results Approximately 62% of patients tested demonstrated reactivity to a stimulus; approximately 48% showed reactivity to the first presented stimulus (calling name). Absence of reactivity was associated with poor outcome; whereas, presence of reactivity was not related to outcome. Inter-rater reliability for the different stimuli ranged from a Kappa statistic of 0.0557 (slight) to 0.4077 (moderate) for different stimuli.

Conclusions A standardized EEG protocol for introducing afferent stimuli to comatose patients during reactivity testing is feasible to implement. Although lack of reactivity was associated with poor outcome, this may reflect a ‘self-fulfilling prophecy’. This standardized protocol is well suited for further assessment by quantitative analysis to determine whether this could improve upon what is currently a subjective test. This protocol is also suited for use with other testing strategies to advance multi-modality testing for prognosis in critically ill comatose patients.

Authors/Disclosures
Derek Debicki, MD PRESENTER	Dr. Debicki has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB Canada Inc.. The institution of Dr. Debicki has received research support from Academic Medical Association of Southwestern Ontario. The institution of Dr. Debicki has received research support from Western BrainScan. The institution of Dr. Debicki has received research support from Lawson Research. The institution of Dr. Debicki has received research support from Canadian Institutes of Health Research.
Mashael O. Khateeb, MD	Dr. Khateeb has nothing to disclose.
	No disclosure on file
Teneille Gofton, MD (London Health Sciences Centre)	The institution of Dr. Gofton has received research support from Government of Canada. The institution of Dr. Gofton has received research support from Canadian Institutes of Health Research. The institution of Dr. Gofton has received research support from Academic Medical Organisation of Southwestern Ontario. The institution of Dr. Gofton has received research support from Lawson Health Research Institute. Dr. Gofton has a non-compensated relationship as a Medical Advisory Board Member with NORSE Institute that is relevant to �鶹��ýӳ�� interests or activities.

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