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Abstract Details

Predictors of need for neurocritical care directed management of suspected nonconvulsive status epilepticus
Neuro Trauma, Critical Care, and Sports Neurology
Neurocritical Care Posters (7:00 AM-5:00 PM)
028
To identify factors that predict need for specialized, neurocritical care unit (NCCU) management for suspected nonconvulsive status epilepticus (NCSE). 
Appreciation for NCSE has led to increased admissions to the NCCU for continuous electroencephalography (cEEG). Biomarkers to predict NCSE to aid in the triage of requests for NCCU beds are not established.   
A retrospective review of patients accepted to the NCCU for possible NCSE was conducted. Demographics, medical history, diagnostic studies, cEEG results and records of medication management were collected. Need for NCCU-directed care was defined as seizures captured on cEEG, use of anesthetic drips for seizure management, or increase in anti-epileptic dosage or medications based on cEEG results. Descriptive statistics were used to characterize the patient cohort, treatment modalities and cEEG findings. Multivariate logistic regressions were employed to identify risk factors for NCCU need and ongoing NCSE on cEEG.
One-hundred and ninety-eight patients were included. Forty-six percent required NCCU-directed care; 21% were found to be in NCSE on cEEG. Glasgow Coma Scale score (Odds Ratio [OR] 0.81, 95% Confidence Interval [CI] 0.72-0.92) and intubated status (OR 3.47, 95% CI 1.17-10.31) independently predicted need for NCCU-directed care. Routine EEG at a referring facility showing seizure or findings on the ictal-interictal continuum (IIC) were associated with NCCU need (OR 5.96, 95% CI 1.57-22.60). Appropriate levetiracetam load (OR 0.09, 95% CI 0.02-0.46), number of medications appropriately loaded (OR 0.21, 95% CI 0.05-0.80) and number of anesthetic drips (OR 0.55, 95% CI 0.32-0.94) were protective against finding NCSE on cEEG following transfer from an outside facility.
Lower GCS, intubated status and seizures or IIC on routine EEG predict NCCU need and may be helpful to consider in triage of transfer requests for patients with suspected NCSE. Appropriate loading of anti-epileptics and use of anesthetic drips prior to transfer are protective against ongoing NCSE.
Authors/Disclosures
Matthew R. Woodward, DO (University of Maryland Medical Center)
PRESENTER 		Dr. Woodward has nothing to disclose.
Sai S. Divakaruni, MD, PhD (Johns Hopkins University School of Medicine) Dr. Divakaruni has nothing to disclose.
Ashwin Reddi, MD (Rush University Medical Center) Dr. Reddi has nothing to disclose.
Neeraj Badjatia, MD (University of Maryland School of Medicine) The institution of Dr. Badjatia has received research support from NIH/DOD.
Nicholas A. Morris, MD, FAAN (University of Maryland Medical Center) Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for HANCOCK, DANIEL & JOHNSON, P.C.. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for The Jacob D. Fuchsberg Law Firm. The institution of Dr. Morris has received research support from National Institute of Neurological Disorders and Stroke. The institution of Dr. Morris has received research support from 好色先生. Dr. Morris has received personal compensation in the range of $0-$499 for serving as a Grand Rounds Speaker with New York University. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Speaker with Mount Sinai Health System. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as a Continuum Article Author with 好色先生. Dr. Morris has received personal compensation in the range of $0-$499 for serving as a Reviewer with Society of Critical Care Medicine. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Speaker with New York Medical College. Dr. Morris has received personal compensation in the range of $500-$4,999 for serving as a Webinar Speaker with Kreg Therapeutics. Dr. Morris has a non-compensated relationship as a Editorial Board Member with 好色先生 that is relevant to AAN interests or activities. Dr. Morris has a non-compensated relationship as a Editorial Board Member with Neurocritical Care Society that is relevant to AAN interests or activities.