Work

Effects of Epileptiform Activity on Discharge Outcome in Critically Ill Patients

Year: 2022

Type: preprint

Abstract: **Background.** Epileptiform activity (EA) — seizures and the ictal-interictal continuum — is common on continuous EEG in critically ill patients, but whether, and how much, EA burden _causes_ worse outcomes (as opposed to marking sicker patients) has been difficult to establish. This project releases de-identified data and a self-contained reproduction pipeline for a causal-inference study of this question. **Methods.** In critically ill adults on continuous EEG, per-patient EA burden was quantified from 2-second EEG segments. Each patient's response to antiseizure medication was modelled with a one-compartment pharmacokinetic model and a Hill/auto-regressive pharmacodynamic model, allowing simulation of the counterfactual EA burden _in the absence of treatment_. The causal effect of untreated EA burden on poor discharge outcome (modified Rankin Scale ≥ 4) was estimated by MALTS (Matching After Learning To Stretch) matching on clinical and pharmacodynamic confounders. **Results.** Higher untreated EA burden was associated with a higher probability of poor outcome in a dose-dependent manner. This release contains the de-identified analysis data (EA-burden time series, drug dosing, confounders, discharge outcome for ~1,300 patients), the fitted PK-PD simulator and parameters, the MALTS estimator, and a one-command script that reproduces the paper's headline causal estimates.

Source: arXiv (Cornell University)

DOI: 10.48550/arxiv.2203.04920