Ceribell

Ceribell

Delirium is an acute disorder affecting up to 80% of intensive care unit (ICU) patients. It is associated with a 10-fold increase in cognitiveimpairment, triples the rate of in-hospital mortality, and costs $164 billion annually. Delirium acutely affects attention and global cognitive function with fluctuating symptoms caused by underlying organic etiologies. Early detection is crucial because the longer a patient experiences delirium the worse it becomes and the harder it is to treat. Currently, identification is through intermittent clinical assessment using standardized tools, like the Confusion Assessment Method for ICU. Such tools work well in clinical research but do not translate well into clinical practice because they are subjective, intermittent and have low sensitivity. As such, healthcare providers using these tools fail to recognize delirium symptoms as much as 80% of the time. Delirium-related biochemical derangement leads to electrical changes in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. However, continuous EEG monitoring is not feasible due to cost and need for skilled interpretation. Studies using limited-lead EEG show large differences between patients with and without delirium while discriminating delirium from other causes. The Ceribell is a limited-lead device that analyzes EEG. If it is capable of detecting delirium, it would provide an objective physiological monitor to identify delirium before symptom onset. This pilot study was designed to explore relationships between Ceribell and delirium status. Completion of this study will provide a foundation for further research regarding delirium status using the Ceribell data 1).

Brain Stethoscope Training from Ceribell on Vimeo.

1)

Mulkey MA, Hardin SR, Munro CL, Everhart DE, Kim S, Schoemann AM, Olson DM. Methods of identifying delirium: A research protocol. Res Nurs Health. 2019 May 30. doi: 10.1002/nur.21953. [Epub ahead of print] PubMed PMID: 31148216.

Stereoelectroencephalography electrode implantation accuracy

Stereoelectroencephalography electrode implantation accuracy

The accuracy of stereoelectroencephalography electrode implantation is an important factor in maximizing its safety.

The implantation of deep brain electrodes for SEEG by using intraoperative CT O Arm® and the Vertek® articulated passive arm is a safe and effective technique with adequate accuracy 1).

Robot-assisted stereoelectroencephalography electrode placement is highly accurate and is significantly more accurate than optical frameless neuronavigation (ON). Larger safety margins away from vascular structures should be used when placing deep electrodes in young children and for trajectories that pass through thicker soft tissues such as the temporal region 2).


Patient-customized platforms are comparable in terms of safety, accuracy, and simplicity of use to the existing robotic devices for implantation of depth electrodes 3).


Rodionov et al., established a quality assurance (QA) process to aid advances in implantation accuracy.

The accuracy of three consecutive modifications of a frameless implantation technique was quantified in three cohorts comprising 22, 8, and 23 consecutive patients. The modifications of the technique aimed to increase accuracy of the bolt placement.

The lateral shift of the axis of the implanted bolt at the level of the planned entry point was reduced from a mean of 3.0 ± 1.6 mm to 1.4 ± 0.8 mm. The lateral shift of the axis of the implanted bolt at the level of the planned target point was reduced from a mean of 3.8 ± 2.5 mm to 1.6 ± 0.9 mm.

This QA framework helped to isolate and quantify the factors introducing inaccuracy in SEEG implantation, and to monitor ongoing accuracy and the effect of technique modifications 4).


Granados et al., presented a method robust to electrode bending that can accurately segment contact positions and bolt orientation. The techniques presented will allow further characterisation of bending within different brain regions 5).


References

1)

Narváez-Martínez Y, García S, Roldán P, Torales J, Rumià J. [Stereoelectroencephalography by using O-Arm(®) and Vertek(®) passive articulated arm: Technical note and experience of an epilepsy referral centre]. Neurocirugia (Astur). 2016 Nov – Dec;27(6):277-284. doi: 10.1016/j.neucir.2016.05.002. Spanish. PubMed PMID: 27345416.
2)

Sharma JD, Seunarine KK, Tahir MZ, Tisdall MM. Accuracy of robot-assisted versus optical frameless navigated stereoelectroencephalography electrode placement in children. J Neurosurg Pediatr. 2019 Jan 4;23(3):297-302. doi: 10.3171/2018.10.PEDS18227. PubMed PMID: 30611155.
3)

Yu H, Pistol C, Franklin R, Barborica A. Clinical Accuracy of Customized Stereotactic Fixtures for Stereoelectroencephalography. World Neurosurg. 2018 Jan;109:82-88. doi: 10.1016/j.wneu.2017.09.089. Epub 2017 Sep 22. PubMed PMID: 28951181.
4)

Rodionov R, O’Keeffe A, Nowell M, Rizzi M, Vakharia VN, Wykes V, Eriksson SH, Miserocchi A, McEvoy AW, Ourselin S, Duncan JS. Increasing the accuracy of 3D EEG implantations. J Neurosurg. 2019 May 17:1-8. doi: 10.3171/2019.2.JNS183313. [Epub ahead of print] PubMed PMID: 31100733.
5)

Granados A, Vakharia V, Rodionov R, Schweiger M, Vos SB, O’Keeffe AG, Li K, Wu C, Miserocchi A, McEvoy AW, Clarkson MJ, Duncan JS, Sparks R, Ourselin S. Automatic segmentation of stereoelectroencephalography (SEEG) electrodes post-implantation considering bending. Int J Comput Assist Radiol Surg. 2018 May 7. doi: 10.1007/s11548-018-1740-8. [Epub ahead of print] PubMed PMID: 29736800.

Consolidated Health Economic Evaluation Reporting Standards in Neurosurgery

Consolidated Health Economic Evaluation Reporting Standards

Economic evaluations of health interventions pose a particular challenge for reporting. There is also a need to consolidate and update existing guidelines and promote their use in a user friendly manner. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement is an attempt to consolidate and update previous health economic evaluation guidelines efforts into one current, useful reporting guidance. The primary audiences for the CHEERS statement are researchers reporting economic evaluations and the editors and peer reviewers assessing them for publication.


The increasing number of treatment options and the high costs associated with epilepsy have fostered the development of economic evaluations in epilepsy. It is important to examine the availability and quality of these economic evaluations and to identify potential research gaps. As well as looking at both pharmacologic (antiepileptic drugs [AEDs]) and nonpharmacologic (e.g., epilepsy surgeryketogenic dietvagus nerve stimulation) therapies, a review of Wijnen et al., examines the methodologic quality of the full economic evaluations included. Literature search was performed in MEDLINE, EMBASE, NHS Economic Evaluation Database (NHS EED), Econlit, Web of Science, and CEA Registry. In addition, Cochrane Reviews, Cochrane DARE and Cochrane Health Technology Assessment Databases were used. To identify relevant studies, predefined clinical search strategies were combined with a search filter designed to identify health economic studies. Specific search strategies were devised for the following topics: (1) AEDs, (2) patients with cognitive deficits, (3) elderly patients, (4) epilepsy surgery, (5) ketogenic diet, (6) vagus nerve stimulation, and (7) treatment of (non)convulsive status epilepticus. A total of 40 publications were included in this review, 29 (73%) of which were articles about pharmacologic interventions. Mean quality score of all articles on the Consensus Health Economic Criteria (CHEC)-extended was 81.8%, the lowest quality score being 21.05%, whereas five studies had a score of 100%. Looking at the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), the average quality score was 77.0%, the lowest being 22.7%, and four studies rated as 100%. There was a substantial difference in methodology in all included articles, which hampered the attempt to combine information meaningfully. Overall, the methodologic quality was acceptable; however, some studies performed significantly worse than others. The heterogeneity between the studies stresses the need to define a reference case (e.g., how should an economic evaluation within epilepsy be performed) and to derive consensus on what constitutes “standard optimal care” 1).


The in-hospital treatment of patients with traumatic brain injury (TBI) is considered to be expensive, especially in patients with severe traumatic brain injury. To improve future treatment decision-making, resource allocation and research initiatives, a study of van Dijck et al., from The Netherlands reviewed the in-hospital costs for patients with s-TBI and the quality of study methodology.

systematic review was performed using the following databases: PubMedMEDLINEEmbaseWeb of ScienceCochrane libraryCENTRALEmcarePsycINFOAcademic Search Premier and Google ScholarArticles published before August 2018 reporting in-hospital acute care costs for patients with s-TBI were included. Quality was assessed by using a 19-item checklist based on the CHEERS statement.

Twenty-five out of 2372 articles were included. In-hospital costs per patient were generally high and ranged from $2,130 to $401,808. Variation between study results was primarily caused by methodological heterogeneity and variable patient and treatment characteristics. The quality assessment showed variable study quality with a mean total score of 71% (range 48% – 96%). Especially items concerning cost data scored poorly (49%) because data source, cost calculation methodology and outcome reporting were regularly unmentioned or inadequately reported.

Healthcare consumption and in-hospital costs for patients with s-TBI were high and varied widely between studies. Costs were primarily driven by the length of stay and surgical intervention and increased with higher TBI severity. However, drawing firm conclusions on the actual in-hospital costs of patients sustaining s-TBI was complicated due to variation and inadequate quality of the included studies. Future economic evaluations should focus on the long-term cost-effectiveness of treatment strategies and use guideline recommendations and common data elements to improve study quality 2).

References

1)

Wijnen BFM, van Mastrigt GAPG, Evers SMAA, Gershuni O, Lambrechts DAJE, Majoie MHJM, Postulart D, Aldenkamp BAP, de Kinderen RJA. A systematic review of economic evaluations of treatments for patients with epilepsy. Epilepsia. 2017 May;58(5):706-726. doi: 10.1111/epi.13655. Epub 2017 Jan 18. Review. PubMed PMID: 28098939.
2)

van Dijck JTJM, Dijkman MD, Ophuis RH, de Ruiter GCW, Peul WC, Polinder S. In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment. PLoS One. 2019 May 9;14(5):e0216743. doi: 10.1371/journal.pone.0216743. eCollection 2019. PubMed PMID: 31071199.
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