Abstract Details

Title Continuous EEG Monitoring Practice Variation in TBI: Early Findings in the ELECTRO-BOOST Cohort

Topic Neuro Trauma and Critical Care

Presentation(s) S23 - Neurocritical Care (2:36 PM-2:48 PM)

Poster/Presentation
Number 009

Objective Assess potential practice-pattern variation and referral bias regarding initiation of continuous EEG (cEEG) monitoring in the ELECTRO-BOOST study.

Background ELECTRO-BOOST, an ongoing ancillary study of BOOST-3 (Brain Oxygenation Optimization in Severe TBI), aims to assess associations of seizures and high-frequency EEG patterns on brain oxygenation, intracranial pressure, treatment, and outcome. Enrolled patients undergoing cEEG may differ from those not enrolled, and institutional or regional indications for cEEG may present variability, which can impact our primary analyses. To begin addressing these potential limitations, we explored site-specific differences in baseline characteristics, EEG monitoring type, and duration.

Design/Methods

Variables collected from case report forms for 179 BOOST-3 participants at 12 ELECTRO-BOOST sites were analyzed. Associations between demographic characteristics, hospital, US region, baseline GCS, EEG type (none, routine, or continuous), cEEG duration, and invasive intracranial monitoring duration were assessed using a combination of statistical tests.

Results Participants undergoing cEEG monitoring (n=123), routine EEG (n=10), and no EEG (n=46) had a baseline GCS of 6 (IQR 4-7), 6 (IQR 3-6), and 6 (IQR 5-7), respectively. Those receiving any EEG monitoring had lower baseline GCS (p=0.03). Average cEEG duration across sites was 53.3 hours (95% CI:43.8-62.8) and varied significantly by hospital (p<0.001) and region (p=0.006). EEG monitoring type (p<0.001), race (p<0.001), and ethnicity (p<0.001) differed across hospitals, but sex and age did not. cEEG duration and EEG type did not differ based on demographics. Hospital site was significantly associated with cEEG duration (p<0.001) after adjustment for demographics and injury severity. Invasive intracranial monitoring duration differed based on EEG type (p=0.03).

Conclusions Preliminary review of patient characteristics confirm practice-pattern variation of cEEG monitoring in TBI even after adjusting for baseline demographics and injury severity. Next steps include exploring whether cEEG monitoring introduces additional practice-pattern variation related to medication use (i.e., seizure prophylaxis, sedation, and hyperosmolar therapy) that could confound our results.

Authors/Disclosures
Kaitlyn Piotrowski (Massachusetts General Hospital) PRESENTER	No disclosure on file
Andrew Webb (Massachusetts General Hospital)	Mr. Webb has nothing to disclose.
Ben MacDonald (Mass General Hospital)	No disclosure on file
Eric Rosenthal, MD (Massachusetts General Hospital)	Dr. Rosenthal has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharma, Inc. . Dr. Rosenthal has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceribell, Inc. . The institution of Dr. Rosenthal has received research support from Sage Therapeutics. Dr. Rosenthal has received intellectual property interests from a discovery or technology relating to health care.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
Puneet Uppal (Yale University School of Medicine)	No disclosure on file
Robert Silbergleit	The institution of Robert Silbergleit has received research support from NIH.
Ramon R. Diaz-Arrastia, MD, PhD, FAAN (University of Pennsylvania)	Dr. Diaz-Arrastia has stock in BrainBox, LLC. Dr. Diaz-Arrastia has stock in Nia Therpeutics. The institution of Dr. Diaz-Arrastia has received research support from National Institutes of Health. The institution of Dr. Diaz-Arrastia has received research support from Department of Defense.
Jennifer A. Kim, MD (Yale University School of Medicine)	Dr. Kim has nothing to disclose.
Sharon Yeatts	No disclosure on file
Kan Ding, MD (UT Southwestern Medical Center)	The institution of Dr. Ding has received research support from National Institute of Aging. The institution of Dr. Ding has received research support from NINDS.

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