Value analysis of continuous EEG in patients during therapeutic hypothermia after cardiac arrest

Amy Z. Crepeau, Jennifer E. Fugate, Jayawant Mandrekar, Roger D. White, Eelco F. Wijdicks, Alejandro Rabinstein, Jeffrey W. Britton

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Introduction: Therapeutic hypothermia (TH) is standard of care after ventricular fibrillation cardiac arrest (CA). Continuous EEG monitoring (cEEG) is increasingly used during TH. Analysis regarding value of cEEG utilization in this population in the context of cost and outcome has not been performed. We compared outcome and EEG charges in CA patients with selective versus routine cEEG. Methods: A protocol for TH after CA without routine cEEG was implemented in December 2005, comprising our TH-pre-cEEG cohort. In November 2009, this protocol was changed to include cEEG in all CA-TH patients, comprising our TH-cEEG cohort. Clinical outcome using the Cerebral Performance Category (CPC) at discharge and estimated EEG charges were calculated retrospectively for both cohorts, based on National Charge Data 50th percentile charges expressed in USD per the CMS 2010 Standard Analytical File as reported in Code Correct by MedAssets, Inc. Results: Our TH-pre-cEEG cohort comprised 91 patients, our TH-cEEG cohort 62. In the TH-pre-cEEG cohort, 19 patients (21%) had rEEGs, 4 (4%) underwent cEEG. The mean estimated EEG charges for the TH-pre-cEEG cohort was $1571.59/patient, and TH-cEEG cohort was $4214.93/patient (p< 0.0001). Two patients (2.1%) in the TH-pre-cEEG cohort had seizures, compared to five (8.1%) in the TH-cEEG cohort (p= 0.088). There was no difference in mortality or clinical outcome in these cohorts. Conclusions: Routine use of cEEG during TH after CA improved seizure detection, but not outcomes. There was a three-fold increase in EEG estimated charges with routine use of cEEG.

Original languageEnglish (US)
Pages (from-to)785-789
Number of pages5
JournalResuscitation
Volume85
Issue number6
DOIs
StatePublished - 2014

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Induced Hypothermia
Heart Arrest
Electroencephalography
Seizures

Keywords

  • Cardiac arrest
  • Cost
  • EEG
  • Prognosis
  • Therapeutic hypothermia
  • Value

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine
  • Medicine(all)

Cite this

Value analysis of continuous EEG in patients during therapeutic hypothermia after cardiac arrest. / Crepeau, Amy Z.; Fugate, Jennifer E.; Mandrekar, Jayawant; White, Roger D.; Wijdicks, Eelco F.; Rabinstein, Alejandro; Britton, Jeffrey W.

In: Resuscitation, Vol. 85, No. 6, 2014, p. 785-789.

Research output: Contribution to journalArticle

Crepeau, Amy Z. ; Fugate, Jennifer E. ; Mandrekar, Jayawant ; White, Roger D. ; Wijdicks, Eelco F. ; Rabinstein, Alejandro ; Britton, Jeffrey W. / Value analysis of continuous EEG in patients during therapeutic hypothermia after cardiac arrest. In: Resuscitation. 2014 ; Vol. 85, No. 6. pp. 785-789.
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abstract = "Introduction: Therapeutic hypothermia (TH) is standard of care after ventricular fibrillation cardiac arrest (CA). Continuous EEG monitoring (cEEG) is increasingly used during TH. Analysis regarding value of cEEG utilization in this population in the context of cost and outcome has not been performed. We compared outcome and EEG charges in CA patients with selective versus routine cEEG. Methods: A protocol for TH after CA without routine cEEG was implemented in December 2005, comprising our TH-pre-cEEG cohort. In November 2009, this protocol was changed to include cEEG in all CA-TH patients, comprising our TH-cEEG cohort. Clinical outcome using the Cerebral Performance Category (CPC) at discharge and estimated EEG charges were calculated retrospectively for both cohorts, based on National Charge Data 50th percentile charges expressed in USD per the CMS 2010 Standard Analytical File as reported in Code Correct by MedAssets, Inc. Results: Our TH-pre-cEEG cohort comprised 91 patients, our TH-cEEG cohort 62. In the TH-pre-cEEG cohort, 19 patients (21{\%}) had rEEGs, 4 (4{\%}) underwent cEEG. The mean estimated EEG charges for the TH-pre-cEEG cohort was $1571.59/patient, and TH-cEEG cohort was $4214.93/patient (p< 0.0001). Two patients (2.1{\%}) in the TH-pre-cEEG cohort had seizures, compared to five (8.1{\%}) in the TH-cEEG cohort (p= 0.088). There was no difference in mortality or clinical outcome in these cohorts. Conclusions: Routine use of cEEG during TH after CA improved seizure detection, but not outcomes. There was a three-fold increase in EEG estimated charges with routine use of cEEG.",
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T1 - Value analysis of continuous EEG in patients during therapeutic hypothermia after cardiac arrest

AU - Crepeau, Amy Z.

AU - Fugate, Jennifer E.

AU - Mandrekar, Jayawant

AU - White, Roger D.

AU - Wijdicks, Eelco F.

AU - Rabinstein, Alejandro

AU - Britton, Jeffrey W.

PY - 2014

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N2 - Introduction: Therapeutic hypothermia (TH) is standard of care after ventricular fibrillation cardiac arrest (CA). Continuous EEG monitoring (cEEG) is increasingly used during TH. Analysis regarding value of cEEG utilization in this population in the context of cost and outcome has not been performed. We compared outcome and EEG charges in CA patients with selective versus routine cEEG. Methods: A protocol for TH after CA without routine cEEG was implemented in December 2005, comprising our TH-pre-cEEG cohort. In November 2009, this protocol was changed to include cEEG in all CA-TH patients, comprising our TH-cEEG cohort. Clinical outcome using the Cerebral Performance Category (CPC) at discharge and estimated EEG charges were calculated retrospectively for both cohorts, based on National Charge Data 50th percentile charges expressed in USD per the CMS 2010 Standard Analytical File as reported in Code Correct by MedAssets, Inc. Results: Our TH-pre-cEEG cohort comprised 91 patients, our TH-cEEG cohort 62. In the TH-pre-cEEG cohort, 19 patients (21%) had rEEGs, 4 (4%) underwent cEEG. The mean estimated EEG charges for the TH-pre-cEEG cohort was $1571.59/patient, and TH-cEEG cohort was $4214.93/patient (p< 0.0001). Two patients (2.1%) in the TH-pre-cEEG cohort had seizures, compared to five (8.1%) in the TH-cEEG cohort (p= 0.088). There was no difference in mortality or clinical outcome in these cohorts. Conclusions: Routine use of cEEG during TH after CA improved seizure detection, but not outcomes. There was a three-fold increase in EEG estimated charges with routine use of cEEG.

AB - Introduction: Therapeutic hypothermia (TH) is standard of care after ventricular fibrillation cardiac arrest (CA). Continuous EEG monitoring (cEEG) is increasingly used during TH. Analysis regarding value of cEEG utilization in this population in the context of cost and outcome has not been performed. We compared outcome and EEG charges in CA patients with selective versus routine cEEG. Methods: A protocol for TH after CA without routine cEEG was implemented in December 2005, comprising our TH-pre-cEEG cohort. In November 2009, this protocol was changed to include cEEG in all CA-TH patients, comprising our TH-cEEG cohort. Clinical outcome using the Cerebral Performance Category (CPC) at discharge and estimated EEG charges were calculated retrospectively for both cohorts, based on National Charge Data 50th percentile charges expressed in USD per the CMS 2010 Standard Analytical File as reported in Code Correct by MedAssets, Inc. Results: Our TH-pre-cEEG cohort comprised 91 patients, our TH-cEEG cohort 62. In the TH-pre-cEEG cohort, 19 patients (21%) had rEEGs, 4 (4%) underwent cEEG. The mean estimated EEG charges for the TH-pre-cEEG cohort was $1571.59/patient, and TH-cEEG cohort was $4214.93/patient (p< 0.0001). Two patients (2.1%) in the TH-pre-cEEG cohort had seizures, compared to five (8.1%) in the TH-cEEG cohort (p= 0.088). There was no difference in mortality or clinical outcome in these cohorts. Conclusions: Routine use of cEEG during TH after CA improved seizure detection, but not outcomes. There was a three-fold increase in EEG estimated charges with routine use of cEEG.

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KW - Cost

KW - EEG

KW - Prognosis

KW - Therapeutic hypothermia

KW - Value

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