Review the frequency of seizures detected in patients admitted to non-neurologic intensive care units (ICU) versus neurologic ICUs.

Electroencephalogram (EEG) is an essential tool for diagnosing and managing neurological conditions. However, recent data suggest that EEGs in ICU settings often do not reveal significant findings that change management or prognostication, raising concerns about overutilization and excessive monitoring without clear indications, which can strain healthcare resources and increase patient complications.

A single-center retrospective electronic chart review study was conducted. The study included 487 patients aged 18-90, 36.3% female, with video EEG (continuous and routine) in an ICU from January 2021-December 2023. Patients were divided into two groups: non-neurologic ICU  (n=117, 24%) and neurologic ICU  (n=370, 76%). Primary outcomes were incidence of seizures or epileptiform discharges on EEG.

Epileptiform discharges were found in 31.6% in neuro ICU and 17.6% in non-neurologic ICUs (p=0.001). Electrographic seizures were found in 17.1% in neuro ICU and 10.0% in non-neurologic ICUs (p=0.037). When neurology was consulted prior to EEG, epileptiform discharges were detected in 29.9% in neuro ICU and 10.6% in non-neurologic ICUs (p<0.001) and seizures were found in 17.2% of neuro ICU and 5.3% of non-neuro ICU (p<0.001). Encephalopathy (n=284, 58.3%) and seizure-like activity (n=163, 33.5%) were the most common reasons for ordering EEG. EEGs ordered for encephalopathy showed epileptiform discharges in 16.5% and electrographic seizures in 8.5%. EEGs ordered for seizure-like activity showed epileptiform discharges in 28.2% and electrographic seizures in 16.6%.

EEG ordered in the neuro ICU were significantly more likely to find seizures or epileptiform discharges compared with those ordered in non-neuro ICU. Similarly, EEGs ordered after consulting with neurology were significantly more likely to capture seizures or epileptiform discharges. This study highlights the importance of utilizing EEGs judiciously and that neurology consultation may be beneficial for optimizing EEG outcomes.