serval:BIB_220E849B159B
Does Continuous Video-EEG in Patients With Altered Consciousness Improve Patient Outcome? Current Evidence and Randomized Controlled Trial Design.
10.1097/WNP.0000000000000467
000457848000001
29533307
Rossetti
A.O.
author
Schindler
K.
author
Alvarez
V.
author
Sutter
R.
author
Novy
J.
author
Oddo
M.
author
Warpelin-Decrausaz
L.
author
Rüegg
S.
author
article
review
2018-09
Journal of clinical neurophysiology
1537-1603
0736-0258
journal
35
5
359-364
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.
Consciousness Disorders/economics
Consciousness Disorders/therapy
Electroencephalography/economics
Humans
Neurophysiological Monitoring/economics
Randomized Controlled Trials as Topic
Research Design
Treatment Outcome
Video Recording
eng
60_published
peer-reviewed
Publication types: Journal Article ; Review
Publication Status: ppublish
University of Lausanne
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