1. Effects of epileptiform activity on discharge outcome in critically ill patients in the USA: a retrospective cross-sectional study
- Author
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Harsh Parikh, PhD, Kentaro Hoffman, PhD, Haoqi Sun, PhD, Sahar F Zafar, MD, Wendong Ge, PhD, Jin Jing, PhD, Lin Liu, PhD, Jimeng Sun, ProfPhD, Aaron Struck, MD, Alexander Volfovsky, PhD, Cynthia Rudin, ProfPhD, and M Brandon Westover, ProfMD PhD
- Subjects
Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Summary: Background: Epileptiform activity is associated with worse patient outcomes, including increased risk of disability and death. However, the effect of epileptiform activity on neurological outcome is confounded by the feedback between treatment with antiseizure medications and epileptiform activity burden. We aimed to quantify the heterogeneous effects of epileptiform activity with an interpretability-centred approach. Methods: We did a retrospective, cross-sectional study of patients in the intensive care unit who were admitted to Massachusetts General Hospital (Boston, MA, USA). Participants were aged 18 years or older and had electrographic epileptiform activity identified by a clinical neurophysiologist or epileptologist. The outcome was the dichotomised modified Rankin Scale (mRS) at discharge and the exposure was epileptiform activity burden defined as mean or maximum proportion of time spent with epileptiform activity in 6 h windows in the first 24 h of electroencephalography. We estimated the change in discharge mRS if everyone in the dataset had experienced a specific epileptiform activity burden and were untreated. We combined pharmacological modelling with an interpretable matching method to account for confounding and epileptiform activity–antiseizure medication feedback. The quality of the matched groups was validated by the neurologists. Findings: Between Dec 1, 2011, and Oct 14, 2017, 1514 patients were admitted to Massachusetts General Hospital intensive care unit, 995 (66%) of whom were included in the analysis. Compared with patients with a maximum epileptiform activity of 0 to less than 25%, patients with a maximum epileptiform activity burden of 75% or more when untreated had a mean 22·27% (SD 0·92) increased chance of a poor outcome (severe disability or death). Moderate but long-lasting epileptiform activity (mean epileptiform activity burden 2% to
- Published
- 2023
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