Journal of Pediatric Epilepsy
DOI: 10.1055/s-0044-1788052
Runi Tanna
1
Department of Pediatrics, University of California, San Francisco, San Francisco,
California, United States
2
Department of Neurology, University of California, San Francisco, San Francisco, California,
United States
,
Edilberto Amorim
2
Department of Neurology, University of California, San Francisco, San Francisco, California,
United States
,
1
Department of Pediatrics, University of California, San Francisco, San Francisco,
California, United States
2
Department of Neurology, University of California, San Francisco, San Francisco, California,
United States
› Author AffiliationsFunding M.C. and E.A. received joint funding from the University of California, San Francisco
Catalyst Program. E.A. is a principal investigator in several active grants supported
by the NIH (1K23NS119794), the Department of Defense (EP220036), American Heart Association
(20CDA35310297 and Harold Amos Medical Faculty Development Award), Cures Within Reach,
and the Zoll Foundation.
› Further InformationAlso available at
![SFX Search]()
Buy Article Permissions and Reprints
Abstract
Significance Recognition of intracranial hemorrhage is challenging in children who require deep
sedation to tolerate mechanical ventilation. The Correlate Of Injury to the Nervous
System (COIN) index may enable real-time recognition of intracranial hemorrhage at
bedside.
Methods Retrospective analysis of electroencephalography (EEG) data from children with spontaneous
intracranial hemorrhage while intubated and sedated in the pediatric intensive care
unit. Patients were selected for having normal head imaging at time of EEG start and
required demonstration of hemorrhage on repeat imaging following an uninterrupted
period of EEG recording. Power spectrum data were analyzed to yield a COIN value and
visualization for every 4 seconds of recording. EEG recordings were subdivided based
on COIN-risk alarm states (low, medium, or high). Changes in COIN were compared with
changes in commercially available quantitative EEG trending software. COIN values
for each subdivision were compared within cases using the Wilcoxon Rank-Sum Test.
Results Two children developed spontaneous intracranial hemorrhage while intubated. COIN
shows transitions from low-to-medium (p < 0.001) and medium-to-high-risk (p < 0.001 in both cases) alarm states. Discrete transitions in COIN alarm state preceded
clinical recognition of hemorrhage by several hours. COIN visualized focal power attenuation
concordant with hemorrhage localization. In both cases, qualitative EEG was not reported
to have focal abnormalities during the medium-risk alarm state.
Conclusion COIN may assist in real-time recognition of intracranial hemorrhage in children at
bedside. Further study and development are required for clinical implementation of
COIN in several clinical settings where patients are at high risk of new or worsening
intracranial hemorrhage.
Keywords
quantitative EEG -
neuromonitoring -
intracranial hemorrhage -
pediatric neurocritical care
Publication History
Received: 01 May 2024
Accepted: 14 June 2024
Article published online:
05 July 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
References
1
Loggini A,
Del Brutto VJ,
El Ammar F.
et al.
Intracranial hemorrhage in hospitalized patients: an infrequently studied condition
with high mortality. Neurocrit Care 2020; 33 (03) 725-731
2
Tahir RA,
Rotman LE,
Davis MC.
et al.
Intracranial hemorrhage in patients with a left ventricular assist device. World Neurosurg
2018; 113: e714-e721
3
Cavayas YA,
Del Sorbo L,
Fan E.
Intracranial hemorrhage in adults on ECMO. Perfusion 2018; 33 (1_suppl): 42-50
4
Werho DK,
Pasquali SK,
Yu S.
et al;
ELSO Member Centers.
Epidemiology of stroke in pediatric cardiac surgical patients supported with extracorporeal
membrane oxygenation. Ann Thorac Surg 2015; 100 (05) 1751-1757
5
Chen CY,
Tai CH,
Cheng A.
et al.
Intracranial hemorrhage in adult patients with hematological malignancies. BMC Med
2012; 10 (01) 97
6
Najima Y,
Ohashi K,
Miyazawa M.
et al.
Intracranial hemorrhage following allogeneic hematopoietic stem cell transplantation.
Am J Hematol 2009; 84 (05) 298-301
7
Curley MAQ,
Wypij D,
Watson RS.
et al;
RESTORE Study Investigators and the Pediatric Acute Lung Injury and Sepsis Investigators
Network.
Protocolized sedation vs usual care in pediatric patients mechanically ventilated
for acute respiratory failure: a randomized clinical trial. JAMA 2015; 313 (04) 379-389
8
Cheng HH,
Rajagopal S,
McDavitt E.
et al.
Stroke in acquired and congenital heart disease patients and its relationship to hospital
mortality and lasting neurologic deficits. Pediatr Crit Care Med 2016; 17 (10) 976-983
9
Hanalioglu D,
Temkit M,
Hildebrandt K.
et al.
Neurophysiologic features reflecting brain injury during pediatric ECMO support. Neurocrit
Care 2024; 40 (02) 759-768
10
Benedetti GM,
Morgan LA,
Sansevere AJ.
et al;
Pediatric Quantitative EEG Strategic Taskforce (PedQuEST).
The Spectrum of quantitative EEG utilization across North America: a cross-sectional
survey. Pediatr Neurol 2023; 141: 1-8
11
Gavvala J,
Abend N,
LaRoche S.
et al;
Critical Care EEG Monitoring Research Consortium (CCEMRC).
Continuous EEG monitoring: a survey of neurophysiologists and neurointensivists. Epilepsia
2014; 55 (11) 1864-1871
12
Caffarelli M,
Karukonda V,
Aghaeeaval M.
et al;
SIPS Investigators.
A quantitative EEG index for the recognition of arterial ischemic stroke in children.
Clin Neurophysiol 2023; 156: 113-124
13
Oostenveld R,
Fries P,
Maris E,
Schoffelen JM.
FieldTrip: open source software for advanced analysis of MEG, EEG, and invasive electrophysiological
data. Comput Intell Neurosci 2011; 2011: 156869
14
McMichael ABV,
Ryerson LM,
Ratano D,
Fan E,
Faraoni D,
Annich GM.
2021 ELSO adult and pediatric anticoagulation guidelines. ASAIO J 2022; 68 (03) 303-310
15
Claassen J,
Hirsch LJ,
Kreiter KT.
et al.
Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with
poor-grade subarachnoid hemorrhage. Clin Neurophysiol 2004; 115 (12) 2699-2710
16
van Putten MJAM.
The revised brain symmetry index. Clin Neurophysiol 2007; 118 (11) 2362-2367
17
Sansevere AJ,
DiBacco ML,
Akhondi-Asl A.
et al.
EEG features of brain injury during extracorporeal membrane oxygenation in children.
Neurology 2020; 95 (10) e1372-e1380
18
Abend NS,
Arndt DH,
Carpenter JL.
et al.
Electrographic seizures in pediatric ICU patients: cohort study of risk factors and
mortality. Neurology 2013; 81 (04) 383-391
19
Herman ST,
Abend NS,
Bleck TP.
et al;
Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society.
Consensus statement on continuous EEG in critically ill adults and children, part
I: indications. J Clin Neurophysiol 2015; 32 (02) 87-95
Comments (0)