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Continuous and routine EEG in intensive care: utilization and outcomes, United States 2005-2009.

ABSTRACT: OBJECTIVES: To evaluate the effect of intensive care unit continuous EEG (cEEG) monitoring on inpatient mortality, hospital charges, and length of stay. METHODS: A retrospective cross-sectional study was conducted using the Nationwide Inpatient Sample, a dataset representing 20% of inpatient discharges in nonfederal US hospitals. Adult discharge records reporting mechanical ventilation and EEG (routine EEG or cEEG) were included. cEEG was compared with routine EEG alone in association with the primary outcome of in-hospital mortality and secondary outcomes of total hospital charges and length of stay. Demographics, hospital characteristics, and medical comorbidity were used for multivariate adjustments of the primary and secondary outcomes. RESULTS: A total of 40,945 patient discharges in the weighted sample met inclusion criteria, of which 5,949 had reported cEEG. Mechanically ventilated patients receiving cEEG were younger than routine EEG patients (56 vs 61 years; p < 0.001). There was no difference in the 2 groups in income or medical comorbidities. cEEG was significantly associated with lower in-hospital mortality in both univariate (odds ratio = 0.54, 95% confidence interval 0.45-0.64; p < 0.001) and multivariate (odds ratio = 0.63, 95% confidence interval 0.51-0.76; p < 0.001) analyses. There was no significant difference in costs or length of stay for patients who received cEEG relative to those receiving only routine EEG. Sensitivity analysis showed that adjusting for diagnosis-related groups (DRGs) for any neurologic diagnoses, DRGs for neurologic procedures, and specific DRGs for epilepsy/convulsions did not substantially alter the association of cEEG with reduced inpatient mortality. CONCLUSIONS: cEEG is favorably associated with inpatient survival in mechanically ventilated patients, without adding significant charges to the hospital stay.

SUBMITTER: Ney JP

PROVIDER: S-EPMC3854828 | biostudies-other | 2013 Dec

REPOSITORIES: biostudies-other

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Continuous and routine EEG in intensive care: utilization and outcomes, United States 2005-2009.

Ney John P JP van der Goes David N DN Nuwer Marc R MR Nelson Lonnie L Eccher Matthew A MA

Neurology 20131101 23

<h4>Objectives</h4>To evaluate the effect of intensive care unit continuous EEG (cEEG) monitoring on inpatient mortality, hospital charges, and length of stay.<h4>Methods</h4>A retrospective cross-sectional study was conducted using the Nationwide Inpatient Sample, a dataset representing 20% of inpatient discharges in nonfederal US hospitals. Adult discharge records reporting mechanical ventilation and EEG (routine EEG or cEEG) were included. cEEG was compared with routine EEG alone in associati ...[more]

PMID: 24186910

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Project description:STUDY DESIGN:A retrospective cohort study. OBJECTIVE:The aim of this study was to examine variation in spine surgery utilization between the province of Ontario and state of New York among all patients and pre-specified patient subgroups. SUMMARY OF BACKGROUND DATA:Spine surgery is common and costly. Within-country variation in utilization is well studied, but there has been little exploration of variation in spine surgery utilization between countries. METHODS:We used population-level administrative data from Ontario (years 2011-2015) and New York (2011-2014) to identify all adults who underwent inpatient spinal decompression or fusion surgery using relevant procedure codes. Patients were stratified according to age and surgical urgency (elective vs. emergent). We calculated standardized utilization rates (procedures per-10,000 population per year) for each jurisdiction. We compared Ontario and New York with respect to patient demographics and the percentage of hospitals performing spine surgery. We compared utilization rates of spinal decompression and fusion surgery in Ontario and New York among all patients and after stratifying by surgical urgency and patient age. RESULTS:Patients in Ontario were older than patients in New York for both decompression (mean age 58.8 vs. 51.3 years; P?<?0.001) and fusion (58.1 vs. 54.9; P?<?0.001). A smaller percentage of hospitals in Ontario than New York performed decompression (26.1% vs. 54.9%; P?<?0.001) or fusion (15.2% vs. 56.7%; P?<?0.001). Overall, utilization of spine surgery (decompression plus fusion) in Ontario was 6.6 procedures per-10,000 population per-year and in New York was 16.5 per-10,000 per-year (P?<?0.001). Ontario-New York differences in utilization were smaller for emergent cases (2.0 per 10,000 in Ontario vs. 2.5 in New York; P?<?0.001), but larger for elective cases (4.6 vs. 13.9; P?<?0.001). The lower utilization in Ontario was particularly large among younger patients (age <60 years). CONCLUSION:We found significantly lower utilization of spine surgery in Ontario than in New York. These differences should inform policy reforms in both jurisdictions. LEVEL OF EVIDENCE:3.

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Continuous and routine EEG in intensive care: utilization and outcomes, United States 2005-2009.

Publications

Continuous and routine EEG in intensive care: utilization and outcomes, United States 2005-2009.

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