Skin Integrity During Prolonged EEG Recording in Hospitalized Neonatal and Pediatric Patients (P3.247)

Objective: To identify the incidence of and potential risk factors contributing to skin injury during continuous EEG (cEEG) recordings. Background: Skin irritation is a known but underreported complication of EEG monitoring. Despite increasing national concern around this issue, there is limited data about the mechanism, risk factors, and incidence of such complications. Methods:Two year cross-sectional study of patients admitted to Children’s National undergoing cEEG who developed skin breakdown at electrode sites.Wet electrodes were applied conventionally in the International 10-20 positions using Nuprep (Weaver & Co., Aurora, CO) and LemonPrepTM (Madivon Corp., Lake Worth, FL),and filled with Ten20 (Weaver& Co., Aurora, CO) conductive paste then wrapped lightly with gauze. Our Wound Team is typically contacted for a disruption of skin integrity greater than a Stage 1 pressure ulcer. Patients were identified from a Wound Team consult log. Clinical variables examined include:age, hospital location, sepsis, nutritional status, coagulopathies, cEEG duration, concurrent therapeutic hypothermia, allergies, and skin issues.Risk for skin breakdown was examined for all EEGs, EEGs performed per hospital location (non-ICU, all ICUs, NICU, CICU, PICU) and compared relative to the risk of a single day of EEG in a non-ICU patient. Chi square test was used to determine p values. Results:7920 patients received cEEG between 2013-2015: NICU (N=500), PICU (N=1102), CICU (N=202), Non-ICU (N=6116).Median cumulative duration of cEEG was 1 day(30 minutes to 29 days). Skin injury, from scalp excoriation to deep tissue injury occurred in 7 patients (0.09[percnt]). ICU patients had a higher incidence of skin injury compared to non-ICU patients (0.28[percnt] vs 0.03[percnt], p=0.002),particularly NICU (0.6[percnt], p<0.001) and CICU patients (0.5[percnt], p=0.003). Conclusions:Critical illness and prolonged cEEG recordings are common in patients with skin injury. Limitations of the study include a selection bias for more significant skin injuries since the wound care team is not consulted for skin erythema. Disclosure: Dr. Pasupuleti has nothing to disclose. Dr. Amling has nothing to disclose. Dr. Chang has nothing to disclose. Dr. Scafidi has nothing to disclose. Dr. Tsuchida has nothing to disclose.