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Journal of Pediatric Epilepsy
DOI: 10.1055/s-0044-1788052
Case Report

A Bedside Screening Tool for Acute Intracranial Hemorrhages in Intubated Children using Continuous Quantitative Electroencephalography Monitoring

Runi Tanna
1   Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States
2   Department of Neurology, University of California, San Francisco, San Francisco, California, United States
,
Edilberto Amorim
2   Department of Neurology, University of California, San Francisco, San Francisco, California, United States
,
Mauro Caffarelli 
1   Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States
2   Department of Neurology, University of California, San Francisco, San Francisco, California, United States
› Author Affiliations Funding M.C. and E.A. received joint funding from the University of California, San Francisco Catalyst Program. E.A. is a principal investigator in several active grants supported by the NIH (1K23NS119794), the Department of Defense (EP220036), American Heart Association (20CDA35310297 and Harold Amos Medical Faculty Development Award), Cures Within Reach, and the Zoll Foundation.
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Abstract

Significance Recognition of intracranial hemorrhage is challenging in children who require deep sedation to tolerate mechanical ventilation. The Correlate Of Injury to the Nervous System (COIN) index may enable real-time recognition of intracranial hemorrhage at bedside.

Methods Retrospective analysis of electroencephalography (EEG) data from children with spontaneous intracranial hemorrhage while intubated and sedated in the pediatric intensive care unit. Patients were selected for having normal head imaging at time of EEG start and required demonstration of hemorrhage on repeat imaging following an uninterrupted period of EEG recording. Power spectrum data were analyzed to yield a COIN value and visualization for every 4 seconds of recording. EEG recordings were subdivided based on COIN-risk alarm states (low, medium, or high). Changes in COIN were compared with changes in commercially available quantitative EEG trending software. COIN values for each subdivision were compared within cases using the Wilcoxon Rank-Sum Test.

Results Two children developed spontaneous intracranial hemorrhage while intubated. COIN shows transitions from low-to-medium (p < 0.001) and medium-to-high-risk (p < 0.001 in both cases) alarm states. Discrete transitions in COIN alarm state preceded clinical recognition of hemorrhage by several hours. COIN visualized focal power attenuation concordant with hemorrhage localization. In both cases, qualitative EEG was not reported to have focal abnormalities during the medium-risk alarm state.

Conclusion COIN may assist in real-time recognition of intracranial hemorrhage in children at bedside. Further study and development are required for clinical implementation of COIN in several clinical settings where patients are at high risk of new or worsening intracranial hemorrhage.

Keywords

quantitative EEG - neuromonitoring - intracranial hemorrhage - pediatric neurocritical care


Publication History

Received: 01 May 2024

Accepted: 14 June 2024

Article published online:
05 July 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Stuttgart · New York

 

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