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Struck, Aaron F; Tabaeizadeh, Mohammad; Schmitt, Sarah E; Ruiz, Andres Rodriguez; Swisher, Christa B; Subramaniam, Thanujaa; Hernandez, Christian; Kaleem, Safa; Haider, Hiba A; Cissé, Abbas Fodé; Dhakar, Monica B; Hirsch, Lawrence J; Rosenthal, Eric S; Zafar, Sahar F; Gaspard, Nicholas; Westover, M. Brandon
JAMA neurology, 04/2020, Letnik: 77, Številka: 4Journal Article
IMPORTANCE: Seizure risk stratification is needed to boost inpatient seizure detection and to improve continuous electroencephalogram (cEEG) cost-effectiveness. 2HELPS2B can address this need but requires validation. OBJECTIVE: To use an independent cohort to validate the 2HELPS2B score and develop a practical guide for its use. DESIGN, SETTING, AND PARTICIPANTS: This multicenter retrospective medical record review analyzed clinical and EEG data from patients 18 years or older with a clinical indication for cEEG and an EEG duration of 12 hours or longer who were receiving consecutive cEEG at 6 centers from January 2012 to January 2019. 2HELPS2B was evaluated with the validation cohort using the mean calibration error (CAL), a measure of the difference between prediction and actual results. A Kaplan-Meier survival analysis was used to determine the duration of EEG monitoring to achieve a seizure risk of less than 5% based on the 2HELPS2B score calculated on first- hour (screening) EEG. Participants undergoing elective epilepsy monitoring and those who had experienced cardiac arrest were excluded. No participants who met the inclusion criteria were excluded. MAIN OUTCOMES AND MEASURES: The main outcome was a CAL error of less than 5% in the validation cohort. RESULTS: The study included 2111 participants (median age, 51 years; 1113 men 52.7%; median EEG duration, 48 hours) and the primary outcome was met with a validation cohort CAL error of 4.0% compared with a CAL of 2.7% in the foundational cohort (P = .13). For the 2HELPS2B score calculated on only the first hour of EEG in those without seizures during that hour, the CAL error remained at less than 5.0% at 4.2% and allowed for stratifying patients into low- (2HELPS2B = 0; <5% risk of seizures), medium- (2HELPS2B = 1; 12% risk of seizures), and high-risk (2HELPS2B, ≥2; risk of seizures, >25%) groups. Each of the categories had an associated minimum recommended duration of EEG monitoring to achieve at least a less than 5% risk of seizures, a 2HELPS2B score of 0 at 1-hour screening EEG, a 2HELPS2B score of 1 at 12 hours, and a 2HELPS2B score of 2 or greater at 24 hours. CONCLUSIONS AND RELEVANCE: In this study, 2HELPS2B was validated as a clinical tool to aid in seizure detection, clinical communication, and cEEG use in hospitalized patients. In patients without prior clinical seizures, a screening 1-hour EEG that showed no epileptiform findings was an adequate screen. In patients with any highly epileptiform EEG patterns during the first hour of EEG (ie, a 2HELPS2B score of ≥2), at least 24 hours of recording is recommended.
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JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
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