Application of subhairline EEG montage in intensive care unit: comparison with full montage.

PURPOSE: Problems with the availability of standard EEG monitoring in the intensive care unit have led to the use of recordings that have limited spatial coverage. We studied the performance of limited coverage EEG compared with more traditional full-montage EEG. METHODS: Continuous EEG recordings were performed on 170 patients using the full-montage 10-20 placement of electrodes as a reference recording and an abbreviated montage of electrodes applied below the hairline (subhairline). Recordings were reviewed independently, with the identity of the patients concealed. RESULTS: Seizures were found in 8% of patients. Sensitivity for detecting patients with seizures using the subhairline system was 0.54 [95% confidence interval (95% CI), 0.29-0.77] with specificity of 1.00 (95% CI, 0.97-1.00) and positive predictive value of 1.00 (95% CI, 0.65-1.00). For detecting interictal epileptiform activity, we found sensitivity to be 0.60 (95% CI, 0.46-0.74), specificity to be 0.94 (95% CI, 0.88-0.97), and positive predictive value to be 0.81 (95% CI, 0.65-0.91). Performance was poor for triphasic waves, alpha/theta/spindle coma, and suppression. CONCLUSIONS: The subhairline montage shows excellent specificity for detecting patients with seizure activity but has limited sensitivity. It has relatively poor performance for other EEG phenomena, but further applications in trending and assessing reactivity should be assessed in further studies.

Nurses' accountability for stroke quality of care: part one: Review of the literature on nursing-sensitive patient outcomes.

Over the past decade, an exciting area of research has emerged that demonstrates strong links between specific nursing care activities and patient outcomes. This body of research has resulted in the identification of a set of "nursing-sensitive outcomes"(NSOs). These NSOs may be interpreted with more meaning when they are linked to evidence-based best practice guidelines, which provide a structured means of ensuring care is consistent among all health care team members, across geographic locations, and across care settings. Uptake of evidence-based best practices at the point of care has been shown to have a measurable positive impact on processes of care and patient outcomes. The purpose of this paper is to present a systematic, narrative review of the literature regarding the clinical effectiveness of nursing management strategies on stroke patient outcomes sensitive to nursing interventions. Subsequent investigation will explore current applications of nursing-sensitive outcomes to patients with stroke, and identify and validate measurable NSOs within stroke care delivery.

Seizure detection with a commercially available bedside EEG monitor and the subhairline montage.

INTRODUCTION: Availability of standard, continuous electroencephalography (cEEG) monitoring in ICU is very limited, although commercially available 4-channel modules are present in many ICUs. We investigated the sensitivity of such modules compared with the more complete monitoring with a standard EEG system. METHODS: Seventy patients at high risk of seizures in the medical-surgical intensive care unit and Epilepsy Monitoring Unit were recorded simultaneously for at least 24 h with a 4-channel commercial ICU bedside monitoring system (Datex-Ohmeda) with a subhairline montage and a standard EEG machine (XLTEK) using the international 10-20 system of electrode placement. Recordings were interpreted independently from each other. RESULTS: The 4-channel recordings demonstrated a sensitivity of 68 and 98% specificity for seizure detection, and a sensitivity of 39% and a specificity of 92% for detection of spikes and PLEDs. CONCLUSIONS: The 4-channel EEG module has limited but practical usefulness for seizure detection when standard cEEG monitoring is not available.

Usefulness of a 1.5 T MRI-compatible EEG electrode system for routine use in the intensive care unit of a tertiary care hospital.

BACKGROUND: Continuous electroencephalogram (cEEG) recordings are being increasingly used in intensive care units (ICUs) to detect epileptic seizures and other changes. MRI scans can interrupt such recordings if the EEG electrodes need to be removed and important data can be missed. METHODS: We retrospectively examined EEG recordings from ICU patients who underwent MRI scans, comparing those from patients with the MRI-compatible EEG electrodes with those who had to have the EEG electrodes removed before scanning. We also examined technical aspects of the recording and scalp abrasions in both groups. RESULTS: Fourteen of 31 (45%) EEG recordings with the MRI-compatible electrode system in patients that underwent MRI scans between 03:00 p.m. and 07:00 a.m. (when technologists were not available) captured seizures. In contrast, all of the six EEG recordings with the MRI-incompatible electrode system in patients that underwent MRI scanning during the same interval were interrupted and had no data. Recording characteristics of the EEGs were comparable between the two groups and none had scalp abrasions. CONCLUSION: A significant proportion of patients undergoing MRI scans with the MRI-compatible EEG electrodes had seizures that would have been missed if the MRI-incompatible EEG electrodes had been used.