Clinical seizure presentation and 60-day mortality among adults selected for continuous EEG in a Saudi intensive care unit: a secondary cohort analysis

Abstract

Clinical seizures at presentation and seizures subsequently detected on continuous electroencephalography (CEEG) describe different stages of an ICU patient's course. We examined whether recorded clinical seizure presentation was associated with mortality within 60 days of admission among adults selected for CEEG in Jeddah, Saudi Arabia. Public patient-level data from King Abdulaziz University Hospital during September 2016–August 2017 were reanalysed under a frozen plan. Age- and sex-adjusted logistic predictions were standardized over eligible adults. Among 192 eligible adult monitoring records, 114 had recorded clinical seizure presentation and 78 did not; 62 deaths were recorded. Unique-person and episode independence could not be verified from the supplied identifiers. Standardized mortality was 29.7% with and 35.9% without presentation, a difference of -6.23 percentage points (95% confidence interval, -19.75 to 7.30; p=0.367). A prespecified Firth model retaining all nominal diagnosis codes estimated a difference of -4.11 percentage points (bootstrap interval, -19.42 to 10.19). Diagnosis labels and totals did not fully reconcile with the source publication. These imprecise estimates do not establish a protective or harmful effect of clinical seizure presentation. Selection for monitoring, unmeasured illness severity, incomplete timing, and unresolved source coding limit interpretation. The study supplies a reproducible local reanalysis and a specification for better prospective data capture; it does not estimate the effectiveness of CEEG or antiseizure treatment.

Keywords

• Saudi Arabia
• neurocritical care
• clinical seizures
• continuous electroencephalography
• mortality
• retrospective cohort
• marginal standardization