Women critically ill adults on EEG have higher intracranial hemorrhage and seizure discharge rates than men

BACKGROUND: Sex-related discrepancies concerning the treatment of patients in intensive care are increasingly described. However, information about management and outcome of critically ill patients undergoing electroencephalography is scarce. OBJECTIVES: This study explores sex-related disparities in management and clinical outcomes in critically ill patients needing electroencephalography for clinical purposes. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS: In this post hoc analysis of the multicenter Continuous Electroencephalography Randomized Trial in Adults (CERTA), which included patients with impaired consciousness requiring electroencephalography, we explored correlations between sex and the timing of electroencephalography, detection of electroencephalography abnormalities, mechanical ventilation, sedation, antiseizure therapy, mortality, and favorable functional outcome (Cerebral Performance Category [CPC] 1-2) at 6 months, using univariable and multivariable analyses. MEASUREMENTS AND MAIN RESULTS: Among 364 patients (33.8% women), women showed a higher prevalence of intracranial hemorrhage (women 30.9%, men 19.5%; p = 0.015) and epileptiform electroencephalography discharges (women 27.6%, men 21.2%; p = 0.008), but use of sedation, antiseizure medication and mechanical ventilation was similar between sexes. Although mortality was similar (adjusted odds ratio [OR], 0.70; 95% CI, 0.39-1.28), women were less likely to reach CPC 1-2 (adjusted OR, 0.50; 95% CI, 0.28-0.90). CONCLUSIONS: Critically ill women and men requiring electroencephalography appear to receive similar clinical management and have comparable mortality, although long-term functional outcome in surviving women is worse. These findings warrant further investigation to identify modifiable factors contributing to sex-related outcome differences.