Data from: Clinical EEG slowing correlates with delirium severity and predicts poor clinical outcomes
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Objective To determine which findings on routine clinical EEGs correlate with delirium severity across various presentations, and to determine whether EEG findings independently predict important clinical outcomes. Methods We prospectively studied a cohort of non-intubated inpatients undergoing EEG for evaluation of altered mental status. Patients were assessed for delirium within one hour of EEG using the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) and 3D-CAM severity score (3D-CAM-S). EEGs were interpreted clinically by neurophysiologists, and reports were reviewed to identify features such as theta or delta slowing and triphasic waves. Generalized linear models were used to quantify associations between EEG findings, delirium, and clinical outcomes, including length of stay, Glasgow Outcome Scale scores, and mortality. Results We evaluated 200 patients (median age 60 years, IQR 48.5-72); 121 (60.5%) met delirium criteria. The EEG finding most strongly associated with delirium presence was a composite of generalized theta or delta slowing (OR 10.3, 95% CI 5.3-20.1). The prevalence of slowing correlated not only with overall delirium severity (R2 = 0.907), but also with the severity of each feature assessed by CAM-based delirium algorithms. Slowing was common in delirium even with normal arousal. EEG slowing was associated with longer hospitalizations, worse functional outcomes, and increased mortality, even after adjusting for delirium presence or severity. Conclusions Generalized slowing on routine clinical EEG strongly correlates with delirium and may be a valuable biomarker for delirium severity. Additionally, generalized EEG slowing should trigger elevated concern for the prognosis of patients with altered mental status.
研究目标 明确不同临床表现下，常规临床脑电图（electroencephalogram, EEG）异常表现与谵妄严重程度的相关性，并探究脑电图异常表现能否独立预测重要临床转归。 研究方法 本研究前瞻性纳入因意识状态改变行脑电图检查的非气管插管住院患者队列。在脑电图检查完成后1小时内，采用3分钟意识模糊评估法诊断访谈（3-Minute Diagnostic Interview for Confusion Assessment Method, 3D-CAM）及3D-CAM严重程度评分（3D-CAM-S）对患者的谵妄状态进行评估。由神经生理学家完成脑电图的临床判读，并审阅脑电图报告以识别θ波、δ波慢化及三相波等异常特征。采用广义线性模型量化脑电图异常表现、谵妄与临床转归（包括住院时长、格拉斯哥预后量表（Glasgow Outcome Scale, GOS）评分及病死率）之间的关联。 研究结果 本研究共纳入200例患者，年龄中位数为60岁，四分位间距为48.5~72岁；其中121例（60.5%）符合谵妄诊断标准。与谵妄发生相关性最强的脑电图异常表现为全面性θ波/δ波慢化（优势比[OR]=10.3，95%置信区间[CI]：5.3~20.1）。慢化现象的发生率不仅与总体谵妄严重程度呈显著相关（决定系数R²=0.907），同时与基于意识模糊评估法的谵妄算法所评估的各特征严重程度相关。即使患者觉醒状态正常，慢化现象在谵妄患者中也较为常见。在校正谵妄发生与否及严重程度后，脑电图慢化仍与更长的住院时长、更差的功能预后及更高的病死率相关。 研究结论 常规临床脑电图检查中出现的全面性慢化现象与谵妄存在强相关性，或可作为评估谵妄严重程度的有效生物标志物。此外，脑电图出现全面性慢化时，临床医师需对意识状态改变患者的预后提高警惕。
