Abstract Details

Title Position and Patient Safety Measures in the Epilepsy Monitoring Unit

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P2 - Poster Session 2 (11:45 AM-12:45 PM)

Poster/Presentation
Number 10-001

Objective To assess effect of surveillance and intervention on patient position after seizure

Background The prone position after seizure may increase risk of apnea. Patient position after seizure is a surrogate marker of safety. The role of active intervention, push-button activation, and remote surveillance on the rate of body position change was

assessed as a surrogate marker for patient safety and physiologic deterioration (postictal bradycardia or the postictal nadir of heart rate (PINHR)).

Design/Methods 102 seizures were analyzed. Video and annotations were reviewed in 30-second epochs from (–)5 minutes to (+)10 minutes after seizure onset and scored for body position, bystander actions, and monitor technician awareness. The primary outcome was the effect of active intervention, push-button response, or monitor watcher response on the duration of position change, timed from seizure onset to first change and PINHR. Cox proportional regression hazard analysis was used with seizure type (major motor vs. other) as a covariate. PINHR vs intervention group was tested with t-test.

Results Changes in body position occurred in 13% (N=13) and 21% of seizures within 30 seconds after onset, and in 21% (N=21) within 5 minutes of onset. Active intervention doubled the rate of position change (OR 2.3, p=0.006, 95% CI 1.28 - 4.16). Similar results were seen with the presence of a push button event (1.8, 0.01, 95% CI 1.13 - 3.02) or monitor watcher event (1.8, 0.02, 95% CI 1.09 - 3.02). Interventions of any type halved the time of the surrogate measure regardless of seizure type. The mean PINHR of seizures with active intervention (76.4 ± 12.8 BPM) was higher than seizures without active intervention (69.7 ± 12 BPM, p=0.002).

Conclusions Active intervention shortens position change time following seizure and may indicate that interventions lessen patient risk. Results remained highly significant regardless of motor symptoms. Active interventions showed decreased propensity for physiologic deterioration (post-ictal bradycardia).

Authors/Disclosures
Pamela O'Dea, MD (IU Health Neuroscience Center) PRESENTER	Dr. O'Dea has nothing to disclose.
Jeffrey Karduck, MD (University of Iowa Hospitals and Clinics)	Dr. Karduck has nothing to disclose.
	No disclosure on file
Andrew C. Schomer, MD (University of Virginia)	No disclosure on file
Mark S. Quigg, MD (UVA Neurology)	Dr. Quigg has received personal compensation for serving as an employee of Natus. Dr. Quigg has received personal compensation for serving as an employee of Neurocrine. Dr. Quigg has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerebral Therapeutics. Dr. Quigg has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerebral Therapeutics. Dr. Quigg has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Finnigen and Harrison. Dr. Quigg has received research support from NIH. Dr. Quigg has received publishing royalties from a publication relating to health care.

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