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ICU nonexperts identified seizures with widely variable qEEG accuracy; patient-specific templates may improve screening

Epileptic disorders : international epilepsy journal with videotape (PubMed)Jul 18, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A 12-study systematic review found that non-neurophysiologists' qEEG seizure-screening accuracy varied widely in ICU patients, with sensitivity ranging from 64% to 100% and specificity from 0% to 95%; patient-specific seizure templates and combined trends appeared to improve performance.

What NurseJet pulled from the source

This systematic review evaluated quantitative EEG (qEEG) seizure identification by non-neurophysiologists in ICU patients. Twelve studies met inclusion criteria, but differences in qEEG displays, reviewer methods, and outcomes prevented meta-analysis. Reported sensitivities ranged from 64% to 100% and specificities from 0% to 95%, with generally low specificity and positive predictive value. Screening tended to perform better when reviewers used several qEEG trends together or compared findings with a confirmed pattern from the same patient's earlier seizure. The review supports qEEG as a rapid screening prompt for expert raw-EEG review, not as an independent diagnostic replacement.

Why this matters for nurses

ICU nurses and other bedside clinicians may be positioned to notice qEEG trend changes between intermittent expert reviews. The review clarifies both the potential for earlier escalation and the risk of false positives or missed seizures.

Bedside takeaway

Nonexpert qEEG screening showed highly variable accuracy, so use it to trigger expert raw-EEG review rather than as a stand-alone diagnosis.

How This Applies in Practice

Use this when: Screening facility-approved qEEG trends for a monitored ICU patient between expert EEG reviews.

On your shift

Compare concerning trends with the system-specific training examples and any confirmed patient-specific seizure template available in the workflow.
Document the event time and clinical context and promptly request qualified review of the corresponding raw EEG.

Keep in mind: qEEG screening does not confirm or exclude a seizure by itself. Follow the neuromonitoring protocol, facility policy, and patient-specific provider orders.

Explain this for my unit

Key takeaways

The systematic review included 12 ICU studies but could not pool results because methods and outcomes differed.
Sensitivity ranged from 64% to 100%, while specificity ranged from 0% to 95%.
Multiple qEEG trends and patient-specific confirmed-seizure templates tended to improve screening performance.
Low specificity and positive predictive value mean suspected events still require expert raw-EEG review.

Practice implications

Use qEEG only within a facility-approved neuromonitoring workflow and apply the display patterns and escalation thresholds taught for that system. When a concerning trend appears, document the timing and clinical context and prompt qualified review of the corresponding raw EEG rather than treating the screen as a diagnosis.

Limitations & cautions

Only 12 heterogeneous studies were eligible, preventing meta-analysis. qEEG trends, reviewer training, seizure definitions, and outcomes varied, and some studies had patient-selection bias concerns. The very broad sensitivity and specificity ranges limit generalization to a particular ICU or display system.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Epileptic disorders : international epilepsy journal with videotape (PubMed)

Epileptic disorders : international epilepsy journal with videotape (PubMed). Seizure identification in the intensive care unit by non-neurophysiologists using quantitative electroencephalogram: A systematic review.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42470659/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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An updated meta-analysis of 13 randomized studies and individual-patient-data meta-analyses found that IV thrombolysis beyond 4.5 hours improved 90-day functional outcomes in selected acute ischemic stroke patients while increasing symptomatic intracranial hemorrhage.

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The pooled evidence included 2,456 patients receiving thrombolysis plus best medical therapy and 2,411 controls. Excellent functional outcome was more likely with thrombolysis, with a reported number needed to treat of 13, while symptomatic intracranial hemorrhage was also more frequent, with a reported number needed to harm of 75. Any intracranial hemorrhage and 90-day mortality did not differ significantly.

Key takeaways

The analysis evaluated thrombolysis initiated more than 4.5 hours after last known well in imaging-selected or otherwise trial-eligible patients.
Excellent and good functional outcomes at 90 days favored thrombolysis across the pooled evidence.
Symptomatic intracranial hemorrhage increased, although any hemorrhage and all-cause mortality were similar between groups.
The findings apply to selected trial populations and do not replace local eligibility, imaging, contraindication, or treatment protocols.

Why this matters on shift

Emergency and neurology nurses help establish last-known-well time, obtain rapid imaging and laboratory data, prepare eligible patients, and detect hemorrhagic or neurologic deterioration after treatment. The review reinforces both the potential benefit of timely extended-window evaluation and the need for close post-thrombolysis surveillance.

Bedside takeaway

Extended-window thrombolysis improved functional outcomes in selected patients but increased symptomatic intracranial hemorrhage.

Nursing implications

Activate the stroke pathway without excluding a patient solely because more than 4.5 hours have elapsed. Capture the timing and eligibility data required by the local protocol, then perform the prescribed neurologic, blood-pressure, and bleeding surveillance if thrombolysis is ordered.

Limitations & cautions

The meta-analysis combined randomized trials and individual-patient-data meta-analyses with different agents, time windows, imaging strategies, vascular territories, and use of endovascular treatment. Selection criteria were trial-specific, and pooled findings do not define eligibility or treatment for an individual patient.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Neurology (PubMed). IV Thrombolysis in the Extended Time Window for Acute Ischemic Stroke: An Updated Systematic Review and Meta-Analysis.

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A clinical review describes ICU nurses as central to coordinated prevention of multidrug-resistant organism transmission through stewardship, pathogen surveillance, appropriate isolation precautions, and evidence-based hygiene practices.

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The review links ICU vulnerability to immunosuppression, invasive devices, broad-spectrum antimicrobial exposure, and the care environment. It emphasizes a multimodal, team-based approach rather than a single intervention, including laboratory and antibiotic stewardship, passive and active surveillance, timely use and de-escalation of precautions, and hygiene measures. The abstract does not report a systematic search or pooled patient outcomes.

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Critically ill patients face overlapping exposure risks related to devices, antimicrobials, immune dysfunction, and the ICU environment.
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Why this matters on shift

ICU nurses are continuously positioned to recognize new transmission risks, maintain device and hygiene practices, and identify when precaution or antimicrobial plans need clarification. The review supports reliable team coordination while leaving organism-specific actions to current infection-prevention guidance.

Bedside takeaway

MDRO prevention in the ICU depends on coordinated surveillance, precautions, stewardship, hygiene, and reliable bedside execution.

Nursing implications

Verify the organism-specific precaution plan at handoff, perform the approved hygiene and device-care bundle, and communicate changes in cultures, antimicrobial therapy, or isolation status. Escalate uncertainty promptly to infection prevention and the treating team.

Limitations & cautions

The PubMed abstract describes a narrative clinical review without a reported systematic search, evidence grading, sample, or pooled effect estimates. It does not establish the comparative effectiveness of specific surveillance, isolation, stewardship, or hygiene interventions, and local resistance patterns may change implementation.
AI-summarized from the linked source. Review the original article before applying to practice.

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Critical care nursing clinics of North America (PubMed). Infection Prevention and Control in the Intensive Care Unit: Preventing the Spread of Multi-Drug-Resistant Organisms.

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The review included 1,045 patients and 1,368 attacks; eight studies with 710 patients and 1,033 attacks contributed to meta-analysis. In optic neuritis, plasmapheresis was associated with improved visual acuity and an estimated 81% excellent-recovery rate, although the confidence interval was very wide. Good recovery was also common in attacks involving myelitis or cerebral disease, and pooled plasmapheresis-related adverse effects were 3%.

Key takeaways

Ten publications included 1,045 patients with 1,368 acute MOGAD attacks.
Eight studies contributed data for meta-analysis, including 710 patients and 1,033 attacks.
Plasmapheresis was associated with visual improvement in optic neuritis and favorable recovery in other attack presentations.
High heterogeneity, variable timing and severity, and the absence of randomized comparisons limit treatment-effect and safety conclusions.

Why this matters on shift

Neurology nurses help recognize evolving visual, motor, sensory, and cerebral symptoms, establish a pre-treatment baseline, and monitor patients during escalation therapy. The review supports careful response tracking while emphasizing that pooled observational recovery rates do not identify who should receive plasmapheresis or when.

Bedside takeaway

Plasmapheresis was associated with recovery in acute MOGAD, but nonrandomized evidence cannot define comparative benefit or optimal timing.

Nursing implications

Document the neurologic and visual baseline before treatment when feasible, follow the ordered plasmapheresis monitoring pathway, and trend the same clinical domains across exchanges. Escalate deterioration, treatment intolerance, or new symptoms promptly through the neurology and apheresis teams.

Limitations & cautions

The evidence came from heterogeneous, nonrandomized studies with differences in attack type, severity, prior treatment, plasmapheresis timing, and outcome definitions. Recovery estimates had wide intervals, confounding by treatment selection is likely, and a low pooled adverse-effect rate cannot establish comparative safety.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Neurology (PubMed). Effectiveness and Safety of Plasmapheresis in MOGAD Attacks: A Systematic Review and Meta-Analysis.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

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