Application Of Quantitative Electroencephalogram On Evaluating Severity Of Brain Function Damage And Prognosis Of Children In PICU With Disturbance Of Consciousness

Objective:To explore the role of early characteristics of Quantitative EEG(qEEG)in the detection of the early impairment of brain function and evaluation of prognostic value of pediatric patiens with impaired consciousness in pediatric intensive care unit(PICU).Method:The children with consciousness disorders who were admitted to the PICU of our hospital from January 2019 to May 2019 were selected as the research subjects.The judgment of unconsciousness is based on the modified Glasgow coma scale(GCS): 15 points are conscious,12 to 14 are mild consciousness,9 to 12 are moderate consciousness,≤8 Severe disturbance of consciousness.Use the Nicolet One brain function monitor(quantitative electroencephalogram)for bedside detection within 24 hours of the patient ’s stay in the PICU and the fourth day of hospitalization,each monitoring time≥4 hours,and record the amplitude-integrated EEG(amplitude-integrated EEG,aEEG),relative band power(RBP),relative alpha variability(RAV),spectral entropy(Spectral entropy,SE)4 quantitative EEG indicators,and simultaneously record video EEG(video EEG,vEEG).With death 3months or 3 months after discharge as the end point of follow-up,telephone follow-up was used to assess the actual prognosis according to the child brain function classification scale,grade 1 to 3 means good prognosis,grade 4 to 6 means bad prognosis.Spearman rank correlation analysis was used to explore the correlation between aEEG,RBP,RAV,SE and vEEG and children’s improved GCS score.AEEG,RBP,RAV,SE,vEEG and children’s improved GCS score were introduced to construct the ROC curve.Results:A total of 82 children were included as the study subjects,including 62 children with consciousness disorders,39 males and 23 females,aged 12 months(5.8months,24 months).There were 20 cases of conscious children,11 males and 9females,with age of 16.5 months(6.5 months,22.5 months).There was no statistical difference between the two groups in gender composition ratio(Z=0.397 P=0.529)and age(Z=0.124 P=0.901).aEEG,SE,RAV and vEEG showed statistically significant differences between the two groups(all P < 0.05),while RBP showed no statistically significant differences between the two groups(P > 0.05).The rate of poor prognosis increased with the increase of background activity abnormalities in aEEG,RAV,SE,vEEG and children’s modified GCS.The differences in the prognosis of children with different grades of aEEG,RAV,SE,vEEG and children with different grades of modified GCS were statistically significant(all P<0.05),while there was no statistically significant difference in the prognosis of children with different grades of RBP(P>0.05).Spearman correlation analysis showed that children’s improved GCS score was positively correlated with aEEG(r=0.632 P < 0.001),RAV(r=0.555 P <0.001),SE(r=0.409 P < 0.001)and vEEG(r=0.689 P < 0.001),but not with RBP(r=0.117 P=0.363).The areas under the ROC curve of various assessment methods were,from large to small,aEEG grading(AUC=0.907),RAV grading(AUC=0.905),children’s improved GCS score(AUC=0.904),vEEG grading(AUC=0.887),SE grading(AUC=0.871)and RBP grading(AUC=0.533).Different prognostic method of optimal cutoff value respectively,aEEG is mildly abnormal,SE,RAV and vEEG areⅢ level,children improved GCS score for moderate disturbance of consciousness,and the best cutoff value for RBP Ⅳ level.AEEG,RAV and SE were no different from vEEG and children’s modified GCS score curve(all P > 0.05).Using Kappa consistency test,the K values of RAV,aEEG,SE,RBP and vEEG were 0.710,0.491,0.559,0.098 and 0.516,respectively.On the 4th day of admission,the scores of aEEG,RAV,SE,RBP,vEEG and children’s improved GCS were 0.763,0.660,0.723,0.067,0.656 and 0.745,respectively,and the scores of aEEG,RAV,SE,RBP,vEEG and children’s improved GCS were 0.763,0.660,0.723,0.067,0.676 and 0.779,respectively.Conclusion:(1)as the degree of background activity abnormality of aEEG,RAV and SE increases,the rate of poor prognosis increases.The three indexes of aEEG,RAV and SE in quantitative electroencephalography can be used to determine the severity of brain injury and predict the prognosis,while RBP cannot determine the degree of brain injury and predict the prognosis.(2)compared with children’s improved GCS score and vEEG,the predictive value of aEEG,RAV and SE in the quantified electroencephalogram is similar,but the quantified electroencephalogram is more accurate and objective than the other two methods,which is more suitable for the monitoring of brain function in children with PICU.(3)through the comparison of jorden index,it was found that the predictive value of aEEG and RAV on the prognosis of children’s brain function on the 4th day of hospitalization was higher than that on the 24 th day of hospitalization,and the predictive value of SE on the prognosis of children’s brain function on the 24 th day of hospitalization was basically the same as that on the 4th day of hospitalization.