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INTRODUCTION: Continuous neurological assessment in the pediatric intensive care unit (PICU) is challenging. Current electroencephalography (EEG) guidelines support monitoring status epilepticus, vasospasm detection, and cardiac arrest prognostication, but the scope of brain dysfunction in critically-ill patients is larger. We explore quantitative electroencephalography (QEEG) in PICU patients with neurological emergencies to identify QEEG changes preceding clinical detection. METHODS: From 2017 to 2020, we identified PICU patients at a single quaternary children’s hospital with EEG recording near or during acute neurological deterioration. QEEG analysis was performed using Persyst P14 (Persyst Development Corporation). Included features were FFT, asymmetry, and rhythmicity spectrograms, “from-baseline” patient-specific versions of above features, and quantitative suppression ratio. Timing of QEEG changes was determined by expert review and prespecified QEEG alert thresholds. Clinical detection of neurologic deterioration was defined pre-hoc and determined by Electronic Medical Record documentation of exam change or intervention. RESULTS: 10 patients were identified, age 23 months to 27 years, 50% female. Of 10 patients, 6 died, 1 had new morbidity, and 3 had good recovery; the most common cause of death was cerebral edema and herniation. The fastest changes were on “from-baseline” FFT spectrograms, while persistent changes on asymmetry spectrograms and suppression ratio were most associated with morbidity and mortality. Median time from first QEEG change to clinical detection was 332 min (Interquartile range: 201 -- 456 min). CONCLUSION: Quantitative EEG is potentially useful in earlier detection of neurological deterioration in critically-ill PICU patients. Further work is required to quantify the predictive value, measure improvement in outcome, and automate the process.