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

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Title: Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study
Authors: Limotai, Chusak, Jirasakuldej, Suda, Wongwiangiunt, Sattawut, Tumnark, Tipakorn, Suwanpakdee, Piradee, Wangponpattanasiri, Kwuanrat, Rakchue, Piyanuch, Tungkasereerak, Chaiwiwat, Pleumpanupatand, Polchai, Tansuhaj, Phopsuk, Ekkachon, Phattarawin, Kittipanprayoon, Songchai, Kerddonfag, Apiwoot, Pobsuk, Thippamas, Pattanateepapon, Anuchate, Phanthumchinda, Kammant, Suwanwela, Nijasri C, Thaipisuttikul, Iyavut, Boonyapisit, Kanokwan, Ingsathit, Atiporn, Pattanaprateep, Oraluck, Attia, John, McKay, Gareth J, Rossetti, Andrea O, Thakkinstian, Ammarin, Rukrung, Chutima, Kangsananont, Patcharapun, Mokkaew, Jeerawan, Phayaph, Nittaya, Pukpraman, Supak, Ritrhathon, Warangkana, Jarungjitapinan, Youwarat, Pinpradab, Jintana, Khamhoi, Netphit, Nookaew, Mayuree, Chauywang, Patchareeporn, Rojdmapitayakorn, Pichai, Sribussara, Paworamon, Tinroongroj, Wasunon, Teeratantikanon, Wisan, Chongsuvivatwong, Tabtim, Viratyaporn, Watchara, Jantararotai, Witoon, Panyawattanakit, Komkrit, Rujirarongrueng, Nopparat, Damthong, Pornnapat, Udom, Pattama, Siengsuwan, Molvipa, Phonprasori, Phatcharamai, Wanmuang, Karnpidcha, Unwanatham, Nattawut, Rattanasiri, Sasivimol, Thadanipon, Kunlawat, Noivong, Panutchaya, Pitipanyakul, Sirincha, Rattanachaisit, Watchara, Muangthong, Wichuta, Wittayawisawasakul, Rachasiri, Deerassamee, Sunisa, Ruayruen, Wannaporn, Homgrunjarut, Supinya, Ledprased, Yupapron, Pankong, Maturos, Rattanayuvakorn, Pentip
Source: Crit Care
Critical care, vol. 29, no. 1, pp. 15
Limotai, C, Jirasakuldej, S, Wongwiangiunt, S, Tumnark, T, Suwanpakdee, P, Wangponpattanasiri, K, Rakchue, P, Tungkasereerak, C, Pleumpanupatand, P, Tansuhaj, P, Ekkachon, P, Kittipanprayoon, S, Kerddonfag, A, Pobsuk, T, Pattanateepapon, A, Phanthumchinda, K, Suwanwela, N C, Thaipisuttikul, I, Boonyapisit, K, Ingsathit, A, Pattanaprateep, O, Attia, J, McKay, G J, Rossetti, A O, Thakkinstian, A, Rukrung, C, Kangsananont, P, Mokkaew, J, Phayaph, N, Pukpraman, S, Ritrhathon, W, Jarungjitapinan, Y, Pinpradab, J, Khamhoi, N, Nookaew, M, Chauywang, P, Rojdmapitayakorn, P, Sribussara, P, Tinroongroj, W, Teeratantikanon, W, Chongsuvivatwong, T, Viratyaporn, W, Jantararotai, W, Panyawattanakit, K, Rujirarongrueng, N, Damthong, P, Udom, P, Siengsuwan, M, Phonprasori, P, Wanmuang, K, Unwanatham, N, Rattanasiri, S, Thadanipon, K, Noivong, P, Pitipanyakul, S, Rattanachaisit, W, Muangthong, W, Wittayawisawasakul, R, Deerassamee, S, Ruayruen, W, Homgrunjarut, S, Deerassamee, S, Ledprased, Y, Pankong, M & Rattanayuvakorn, P 2025, 'Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study', Critical Care, vol. 29, 15, pp. 1. https://doi.org/10.1186/s13054-024-05246-x
Publisher Information: Springer Science and Business Media LLC, 2025.
Publication Year: 2025
Subject Terms: Male, Adult, Intensive Care Units/organization & administration, Electroencephalography/methods, Research, Critical Illness, Electroencephalography, Middle Aged, Telemedicine/statistics & numerical data, Status Epilepticus/diagnosis, Humans, Female, Critical Illness/therapy, Electroencephalography/statistics & numerical data, Thailand, Aged, Telemedicine/standards, Seizures/diagnosis, Delivery of Health Care/standards, Delivery of Health Care/statistics & numerical data, Intensive Care Units/statistics & numerical data, Critically ill patients, Randomized controlled trial, Tele-cRCT, Tele-continuous EEG, Telemedicine, Intensive Care Units, Status Epilepticus, Seizures, Delivery of Health Care
Description: 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.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.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.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.
Document Type: Article
Other literature type
File Description: application/pdf
Language: English
ISSN: 1364-8535
DOI: 10.1186/s13054-024-05246-x
Access URL: https://pubmed.ncbi.nlm.nih.gov/39773282
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https://serval.unil.ch/resource/serval:BIB_289527986D55.P001/REF.pdf
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https://pure.qub.ac.uk/en/publications/9aea6ba8-80d6-4840-96cd-b2a8d402acbe
Rights: CC BY NC ND
Accession Number: edsair.doi.dedup.....08c6712d0805ead55343f792f9af1ffd
Database: OpenAIRE
Description
Abstract: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.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.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.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.
ISSN:13648535
DOI:10.1186/s13054-024-05246-x