TY - JOUR
T1 - Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study
AU - Limotai, Chusak
AU - Jirasakuldej, Suda
AU - Wongwiangiunt, Sattawut
AU - Tumnark, Tipakorn
AU - Suwanpakdee, Piradee
AU - Wangponpattanasiri, Kwuanrat
AU - Rakchue, Piyanuch
AU - Tungkasereerak, Chaiwiwat
AU - Pleumpanupatand, Polchai
AU - Tansuhaj, Phopsuk
AU - Ekkachon, Phattarawin
AU - Kittipanprayoon, Songchai
AU - Kerddonfag, Apiwoot
AU - Pobsuk, Thippamas
AU - Pattanateepapon, Anuchate
AU - Phanthumchinda, Kammant
AU - Suwanwela, Nijasri C
AU - Thaipisuttikul, Iyavut
AU - Boonyapisit, Kanokwan
AU - Ingsathit, Atiporn
AU - Pattanaprateep, Oraluck
AU - Attia, John
AU - McKay, Gareth J
AU - Rossetti, Andrea O
AU - Thakkinstian, Ammarin
AU - Rukrung, Chutima
AU - Kangsananont, Patcharapun
AU - Mokkaew, Jeerawan
AU - Phayaph, Nittaya
AU - Pukpraman, Supak
AU - Ritrhathon, Warangkana
AU - Jarungjitapinan, Youwarat
AU - Pinpradab, Jintana
AU - Khamhoi, Netphit
AU - Nookaew, Mayuree
AU - Chauywang, Patchareeporn
AU - Rojdmapitayakorn, Pichai
AU - Sribussara, Paworamon
AU - Tinroongroj, Wasunon
AU - Teeratantikanon, Wisan
AU - Chongsuvivatwong, Tabtim
AU - Viratyaporn, Watchara
AU - Jantararotai, Witoon
AU - Panyawattanakit, Komkrit
AU - Rujirarongrueng, Nopparat
AU - Damthong, Pornnapat
AU - Udom, Pattama
AU - Siengsuwan, Molvipa
AU - Phonprasori, Phatcharamai
AU - Wanmuang, Karnpidcha
AU - Unwanatham, Nattawut
AU - Rattanasiri, Sasivimol
AU - Thadanipon, Kunlawat
AU - Noivong, Panutchaya
AU - Pitipanyakul, Sirincha
AU - Rattanachaisit, Watchara
AU - Muangthong, Wichuta
AU - Wittayawisawasakul, Rachasiri
AU - Deerassamee, Sunisa
AU - Ruayruen, Wannaporn
AU - Homgrunjarut, Supinya
AU - Deerassamee, Sunisa
AU - Ledprased, Yupapron
AU - Pankong, Maturos
AU - Rattanayuvakorn, Pentip
N1 - © 2025. The Author(s).
PY - 2025/1/7
Y1 - 2025/1/7
N2 - BACKGROUND: Continuous electroencephalography (cEEG) has been recommended in critically ill patients although its efficacy for improving patients' functional status remains unclear. This study aimed to compare the efficacy of Tele-cEEG with Tele-routine EEG (Tele-rEEG), in terms of seizure detection rate, mortality and functional outcomes.METHODS: This study is a 3-year randomized, controlled, parallel, multicenter trial, conducted in eight regional hospitals across Thailand. Eligible participants were critically ill patients aged ≥ 15 years and at-risk for developing nonconvulsive seizure (NCS)/nonconvulsive status epilepticus (NCSE). Study interventions were 24-72 h Tele-cEEG versus 30-min Tele-rEEG. Study outcomes were seizure detection rate, mortality and functional outcomes (mRS), assessed at hospital discharge, ≤ 7 days, 3-, 6-, 9-months and 1 year.RESULTS: Two hundred and fifty-four patients were randomized, 128 and 126 patients received Tele-cEEG and Tele-rEEG, respectively. NCS/NCSE were detected more commonly in the Tele-cEEG (21.88%) than Tele-rEEG arm (14.29%) but this was not statistically significant (p = 0.116). Intention-to-treat, per-protocol and as-treated analysis showed non-significant differences in mortality at all assessment periods, with corresponding mortality rates of 10.03% (Tele-cEEG) versus 10.10% (Tele-rEEG) (p = 0.894), 9.67% versus 9.06% (p = 0.833) and 10.34% versus 9.06% (p = 0.600), respectively. Functional outcome was also not significantly different in all analyses.CONCLUSIONS: Both Tele-cEEG and Tele-rEEG are feasible, although Tele-EEG requires additional EEG specialists, budget, and computational resources. While Tele-cEEG may help detect NCS/NCSE, this study had limited power to detect its efficacy in reducing mortality or improving functional outcomes. In limited-resource settings, Tele-rEEG approximating 30 min or longer offers a feasible and potentially valuable initial screening tool for critically ill patients at-risk of seizures. However, where Tele-cEEG is readily available, it remains the recommended approach. Trial registration Thai Clinical Trials Registry (TTCTR20181022002); Registered 22 October 2018.
AB - BACKGROUND: Continuous electroencephalography (cEEG) has been recommended in critically ill patients although its efficacy for improving patients' functional status remains unclear. This study aimed to compare the efficacy of Tele-cEEG with Tele-routine EEG (Tele-rEEG), in terms of seizure detection rate, mortality and functional outcomes.METHODS: This study is a 3-year randomized, controlled, parallel, multicenter trial, conducted in eight regional hospitals across Thailand. Eligible participants were critically ill patients aged ≥ 15 years and at-risk for developing nonconvulsive seizure (NCS)/nonconvulsive status epilepticus (NCSE). Study interventions were 24-72 h Tele-cEEG versus 30-min Tele-rEEG. Study outcomes were seizure detection rate, mortality and functional outcomes (mRS), assessed at hospital discharge, ≤ 7 days, 3-, 6-, 9-months and 1 year.RESULTS: Two hundred and fifty-four patients were randomized, 128 and 126 patients received Tele-cEEG and Tele-rEEG, respectively. NCS/NCSE were detected more commonly in the Tele-cEEG (21.88%) than Tele-rEEG arm (14.29%) but this was not statistically significant (p = 0.116). Intention-to-treat, per-protocol and as-treated analysis showed non-significant differences in mortality at all assessment periods, with corresponding mortality rates of 10.03% (Tele-cEEG) versus 10.10% (Tele-rEEG) (p = 0.894), 9.67% versus 9.06% (p = 0.833) and 10.34% versus 9.06% (p = 0.600), respectively. Functional outcome was also not significantly different in all analyses.CONCLUSIONS: Both Tele-cEEG and Tele-rEEG are feasible, although Tele-EEG requires additional EEG specialists, budget, and computational resources. While Tele-cEEG may help detect NCS/NCSE, this study had limited power to detect its efficacy in reducing mortality or improving functional outcomes. In limited-resource settings, Tele-rEEG approximating 30 min or longer offers a feasible and potentially valuable initial screening tool for critically ill patients at-risk of seizures. However, where Tele-cEEG is readily available, it remains the recommended approach. Trial registration Thai Clinical Trials Registry (TTCTR20181022002); Registered 22 October 2018.
KW - Humans
KW - Male
KW - Female
KW - Critical Illness/therapy
KW - Middle Aged
KW - Electroencephalography/methods
KW - Thailand
KW - Aged
KW - Telemedicine/statistics & numerical data
KW - Adult
KW - Seizures/diagnosis
KW - Delivery of Health Care/standards
KW - Status Epilepticus/diagnosis
KW - Intensive Care Units/organization & administration
U2 - 10.1186/s13054-024-05246-x
DO - 10.1186/s13054-024-05246-x
M3 - Article
C2 - 39773282
SN - 1466-609X
VL - 29
SP - 1
JO - Critical Care
JF - Critical Care
M1 - 15
ER -