Continuous EEG gave no advantage over repeated routine EEG in ICU patients without brain injury

Design

Post hoc analysis of a multicentre randomised trial

Population

76 critically ill adults without a primary neurological condition

Primary outcome

Six-month mortality

Effect

No difference (p = 0.97); no seizures detected in either arm

CERTA randomised critically ill adults to continuous EEG or two routine EEG recordings. This post hoc analysis looked only at the 76 of 364 patients who had no primary neurological condition (34 continuous, 42 routine).

There was no difference in six-month mortality (p = 0.97) or good functional outcome (p = 0.89). No seizures or status epilepticus were detected in either group, and periodic patterns, ictal–interictal findings, medication changes and infections were similar.

Continuous EEG is expensive and scarce. This small subgroup suggests that for medical ICU patients with altered consciousness but no primary brain disease, repeated routine EEG may be enough. The numbers are small and the analysis was not planned at the trial's design, so it cannot exclude a benefit.

• In ICU patients without primary brain injury, repeated routine EEG appears a reasonable alternative where continuous EEG is unavailable.
• No electrographic seizures were found in this group, which limits what the comparison can show.
• Keep a low threshold for EEG in unexplained encephalopathy, whichever form is available.
• Patients with primary neurological injury were excluded from this analysis.

Why it matters

It questions spending a scarce monitoring resource on patients least likely to benefit.

Don't overread it

A post hoc subgroup of 76 patients cannot show that continuous EEG is no better.

The statistics, in plain English

Large p-values (0.97 and 0.89) mean no difference was seen, but with only 76 patients the study could miss a real effect. Absence of evidence is not evidence of absence here.

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