Does Continuous Video-EEG in Patients With Altered Consciousness Improve Patient Outcome? Current Evidence and Randomized Controlled Trial Design.

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Version: Author's accepted manuscript
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Serval ID
serval:BIB_220E849B159B
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Does Continuous Video-EEG in Patients With Altered Consciousness Improve Patient Outcome? Current Evidence and Randomized Controlled Trial Design.
Journal
Journal of clinical neurophysiology
Author(s)
Rossetti A.O., Schindler K., Alvarez V., Sutter R., Novy J., Oddo M., Warpelin-Decrausaz L., Rüegg S.
ISSN
1537-1603 (Electronic)
ISSN-L
0736-0258
Publication state
Published
Issued date
09/2018
Peer-reviewed
Oui
Volume
35
Number
5
Pages
359-364
Language
english
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Abstract
Continuous video-EEG is recommended for patients with altered consciousness; as compared to routine EEG (lasting <30 minutes), it improves seizure detection, but is time- and resource-consuming. Although North American centers increasingly implement continuous video-EEG, most other (including European) hospitals have insufficient resources. Only one study suggested that continuous video-EEG could improve outcome in adults, and recent assessments challenge this view. This article reviews current evidence on the added value for continuous video-EEG in clinical terms and describes a design for a prospective study.In a multicenter randomized clinical trial (NCT03129438), adults with a Glasgow Coma Scale ≤11 will be randomized 1:1 to continuous video-EEG (cEEG) for 30 to 48 hours or 2 routine EEG (rEEG), assessed through standardized American Clinical Neurophysiology Society (ACNS) guidelines. The primary outcome will be mortality at 6 months, assessed blindly. Secondary outcomes will explore functional status at 4 weeks and 6 months, intensive care unit (ICU) length of stay, infection rates, and hospitalization costs. Using a 2-sided approach with power of 0.8 and a error of 0.05, 2 × 174 patients are needed to detect an absolute survival difference of 14%, suggested by the single available study on the topic.This study should help clarifying whether cEEG has a significant impact on outcome and define its cost effectiveness. If the trial will result positive, it will encourage broader implementation of cEEG with consecutive substantial impact on health care and resource allocations. If not, it may offer a rationale to design a larger trial, and - at least for smaller centers - to avoid widespread implementation of cEEG, rationalizing personnel and device costs.
Keywords
Consciousness Disorders/economics, Consciousness Disorders/therapy, Electroencephalography/economics, Humans, Neurophysiological Monitoring/economics, Randomized Controlled Trials as Topic, Research Design, Treatment Outcome, Video Recording
Pubmed
Web of science
Create date
15/03/2018 18:59
Last modification date
12/09/2019 15:04
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