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. 2025 Jan 1;42(1):20-27.
doi: 10.1097/WNP.0000000000001043. Epub 2023 Oct 30.

Real-World Continuous EEG Utilization and Outcomes in Hospitalized Patients With Acute Cerebrovascular Diseases

Rajesh Amerineni  1 , Haoqi Sun  2 , Marta Bento Fernandes  1 , M Brandon Westover  2 , Lidia Moura  1 , Elisabetta Patorno  3 , John Hsu  4   5 , Sahar F Zafar  1
Affiliations

Real-World Continuous EEG Utilization and Outcomes in Hospitalized Patients With Acute Cerebrovascular Diseases

Rajesh Amerineni et al. J Clin Neurophysiol. .

Abstract

Purpose: Continuous electroencephalography (cEEG) is recommended for hospitalized patients with cerebrovascular diseases and suspected seizures or unexplained neurologic decline. We sought to (1) identify areas of practice variation in cEEG utilization, (2) determine predictors of cEEG utilization, (3) evaluate whether cEEG utilization is associated with outcomes in patients with cerebrovascular diseases.

Methods: This cohort study of the Premier Healthcare Database (2014-2020), included hospitalized patients age > 18 years with cerebrovascular diseases (identified by ICD codes). Continuous electroencephalography was identified by International Classification of Diseases (ICD)/Current Procedural Terminology (CPT) codes. Multivariable lasso logistic regression was used to identify predictors of cEEG utilization and in-hospital mortality. Propensity score-matched analysis was performed to determine the relation between cEEG use and mortality.

Results: 1,179,471 admissions were included; 16,777 (1.4%) underwent cEEG. Total number of cEEGs increased by 364% over 5 years (average 32%/year). On multivariable analysis, top five predictors of cEEG use included seizure diagnosis, hospitals with >500 beds, regions Northeast and South, and anesthetic use. Top predictors of mortality included use of mechanical ventilation, vasopressors, anesthetics, antiseizure medications, and age. Propensity analysis showed that cEEG was associated with lower in-hospital mortality (Average Treatment Effect -0.015 [95% confidence interval -0.028 to -0.003], Odds ratio 0.746 [95% confidence interval, 0.618-0.900]).

Conclusions: There has been a national increase in cEEG utilization for hospitalized patients with cerebrovascular diseases, with practice variation. cEEG utilization was associated with lower in-hospital mortality. Larger comparative studies of cEEG-guided treatments are indicated to inform best practices, guide policy changes for increased access, and create guidelines on triaging and transferring patients to centers with cEEG capability.

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Conflict of interest statement

Potential conflicts of interest

Dr. Amerineni is a data scientist for CertainTeed unrelated to this work. Dr. Zafar is a clinical neurophysiologist for Corticare, unrelated to this work.

Dr. Westover is cofounder of Beacon Biosignals unrelated to this work.

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