Comparison of routine quantitative electroencephalography and bispectral index in aneurysmal subarachnoid hemorrhage

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Abstract

Purpose To compare routine electroencephalography (EEG) and bilateral bispectral index (BIS) monitoring for the detection of DCI in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods In a cohort of patients admitted to our Neurocritical Care Unit (NCCU) due to aSAH, two simultaneous 30-minute EEG and BIS recordings were obtained: one within 72 hours of admission and another at least 48 hours after the initial recording. Quantitative analyses were conducted to identify EEG and BIS parameters associated with DCI. Only frontal EEG channels were analyzed. For the most relevant EEG and BIS variables, Spearman correlation coefficients and Bland-Altman plots were used to assess association and agreement. Results Strong and statistically significant correlations were observed between DCI-related parameters derived from BIS and those from frontal EEG channels. The strongest correlation was found for total power (TPw) on BIS and frontal EEG, showing a Spearman coefficient of ρ: 0.83 (p < 0.001). Bland-Altman analysis demonstrated agreement across both techniques, though with statistically significant negative bias in power, indicating that BIS tends to overestimate compared to EEG. Conclusions Both EEG and BIS appear to be valuable tools for the early detection of DCI. The strong correlation observed between them could support their use as complementary or alternative modalities, depending on institutional resources. However, clinicians should be aware of systematic differences in power measurements between both techniques.

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