Abstract Details

Title Predictive Value of Early Quantitative EEG Features in Critically Ill Moderate-severe Traumatic Brain Injury (TBI) Patient Prognostication

Topic Neuro Trauma and Critical Care

Presentation(s) P12 - Poster Session 12 (11:45 AM-12:45 PM)

Poster/Presentation
Number 7-008

Objective To evaluate predictive performance of quantitative electroencephalogram (qEEG) features in predicting outcomes among moderate-severe traumatic brain injury (msTBI) patients.

Background EEG is utilized among critically ill TBI patients for detection of seizure and non-convulsive status epilepticus; however, role of qEEG in prognostication has not been thoroughly explored.

Design/Methods We conducted a retrospective cohort study using the University of California, Irvine TBI and Concussion (NTBIC) database (10/2023-3/2024). Patients with msTBI (GCS <8, requiring neuromonitoring, complex TBI cases per surgical ICU) were included. Poor outcome was defined as discharge Modified Ranking Scale (mRS) ≥5. For select EEG electrode contacts, 5-minute EEG segments at every 4-hour intervals were extracted from first 24 hours of EEG data. Prognostic capacity of qEEG features were assessed via univariate analysis (t-test/chi-square), multivariable logistic-regression, and mean area under the receiver operating characteristic curve (AUCROC) over a fivefold cross validation. Analysis was conducted using MATLAB/Python.

Results 47 patients (29.8% female, 55.3% non-white) with a mean age of 49.0±22.3 were included. 1 patient had an electrographic seizure. Mean amplitude, delta, beta, and total-power were higher (p<0.05), and there were no differences in use of sedation between patients with good vs. poor outcomes (p>0.05). On multivariate logistic regression, after controlling for age, sex, race, admission GCS, dilated pupil on arrival, and use of any sedation, beta (OR=0.01, 95% CI 0.00-0.54, p=0.023), delta (OR=0.81, 95% CI 0.69-0.96, p=0.013), and total-power (OR=1.16, 95% CI 1.03-1.31, p=0.018) predicted poor outcome. AUCROC using age, admission GCS, and pupils was 0.72±0.17. Adding beta, total-power, and delta, yielded AUCROC of 0.69±0.17, 0.72±0.15, 0.74±0.17 respectively. Combination models of delta/total-power and beta/delta/total-power yielded 0.75±0.18 and 0.77±0.14, respectively.

Conclusions qEEG features, notably beta/delta power and total-power, have satisfactory predictive value of ICU-TBI outcome when added to clinical features. Future studies will prospectively validate models and test alternative machine learning methods.

Authors/Disclosures
Kotaro Tsutsumi, MD PRESENTER	Dr. Tsutsumi has nothing to disclose.
Shenyu Tong (University of California, Irvine)	No disclosure on file
Brian Jung, MD	Dr. Jung has nothing to disclose.
Yama Akbari, MD, PhD (University of California, Irvine)	Dr. Akbari has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for AZ Injury Law. The institution of Dr. Akbari has received research support from NIH. The institution of Dr. Akbari has received research support from Hamamatsu Photonics KK. Dr. Akbari has received intellectual property interests from a discovery or technology relating to health care.
Sara J. Stern-Nezer, MD (University of California, Irvine)	Dr. Stern-Nezer has nothing to disclose.
Cyrus K. Dastur, MD (UC Irvine Medical Center)	Dr. Dastur has nothing to disclose.
Wengui Yu, MD, PhD (UC Irvine, Neurology Dept)	Dr. Yu has nothing to disclose.
Walter W. Valesky, Jr., MD (Suny Downstate Medical Center)	Dr. Valesky has nothing to disclose.
Sonja Darwish, MD	Dr. Darwish has nothing to disclose.
Michelle F. Goodwin, MD	Dr. Goodwin has nothing to disclose.
Jeff W. Chen, MD, PhD	The institution of Dr. Chen has received research support from Mitsubishi.
Michael Lekawa (University of California, Irvine)	No disclosure on file
Areg Grigorian	Areg Grigorian has nothing to disclose.
Jeffry Nahmias, MD, MHPE	Dr. Nahmias has nothing to disclose.
Kurt Y. Qing, MD, PhD (New York Presbyterian Hospital, Weill Cornell Medical Center)	Dr. Qing has nothing to disclose.
Patrick M. Chen, MD (UC Irvine Medical Center)	Dr. Chen has nothing to disclose.

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