Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study

Chusak Limotai, Suda Jirasakuldej, Sattawut Wongwiangiunt, Tipakorn Tumnark, Piradee Suwanpakdee, Kwuanrat Wangponpattanasiri, Piyanuch Rakchue, Chaiwiwat Tungkasereerak, Polchai Pleumpanupatand, Phopsuk Tansuhaj, Phattarawin Ekkachon, Songchai Kittipanprayoon, Apiwoot Kerddonfag, Thippamas Pobsuk, Anuchate Pattanateepapon, Kammant Phanthumchinda, Nijasri C Suwanwela, Iyavut Thaipisuttikul, Kanokwan Boonyapisit, Atiporn IngsathitOraluck Pattanaprateep, John Attia, Gareth J McKay, Andrea O Rossetti, Ammarin Thakkinstian, Chutima Rukrung, Patcharapun Kangsananont, Jeerawan Mokkaew, Nittaya Phayaph, Supak Pukpraman, Warangkana Ritrhathon, Youwarat Jarungjitapinan, Jintana Pinpradab, Netphit Khamhoi, Mayuree Nookaew, Patchareeporn Chauywang, Pichai Rojdmapitayakorn, Paworamon Sribussara, Wasunon Tinroongroj, Wisan Teeratantikanon, Tabtim Chongsuvivatwong, Watchara Viratyaporn, Witoon Jantararotai, Komkrit Panyawattanakit, Nopparat Rujirarongrueng, Pornnapat Damthong, Pattama Udom, Molvipa Siengsuwan, Phatcharamai Phonprasori, Karnpidcha Wanmuang, Nattawut Unwanatham, Sasivimol Rattanasiri, Kunlawat Thadanipon, Panutchaya Noivong, Sirincha Pitipanyakul, Watchara Rattanachaisit, Wichuta Muangthong, Rachasiri Wittayawisawasakul, Sunisa Deerassamee, Wannaporn Ruayruen, Supinya Homgrunjarut, Sunisa Deerassamee, Yupapron Ledprased, Maturos Pankong, Pentip Rattanayuvakorn

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Abstract

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.

Original languageEnglish
Article number15
Pages (from-to)1
JournalCritical Care
Volume29
DOIs
Publication statusPublished - 07 Jan 2025

Bibliographical note

© 2025. The Author(s).

Keywords

  • Humans
  • Male
  • Female
  • Critical Illness/therapy
  • Middle Aged
  • Electroencephalography/methods
  • Thailand
  • Aged
  • Telemedicine/statistics & numerical data
  • Adult
  • Seizures/diagnosis
  • Delivery of Health Care/standards
  • Status Epilepticus/diagnosis
  • Intensive Care Units/organization & administration

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