The Utility of EEG in the Emergency Department
Background and aim Seizure-related visits are common in the emergency department (ED) but the clinical situations for ordering emergency electroencephalography (EEG) are unclear. The aim of this study is to identify which clinical conditions meet with the pathological EEG and whether patient management is changed by abnormal results.
Methods A retrospective chart review study of all patients visiting the ED with a seizure or symptoms mimicking a seizure was performed. Patients who recorded an EEG within 16 h after the initial event were enrolled. Demographic data and EEG results of patients with provoked and unprovoked seizures were recorded and related factors were analysed.
Results A total of 449 patients (219 men) of mean±SD age of 45.48±21.83 years were evaluated. The seizure was thought to be provoked in 98 patients (21.8%) and unprovoked in 352 (78.2%) patients (31.2% remote symptomatic and 47.4% idiopathic). The EEG results of 281 patients (62.6%) revealed an abnormality, and the abnormal EEG ratio was high in patients with presumed seizure (p<0.001). One hundred and thirty-eight patients (30.7%) were hospitalised and the remainder (n=311, 69.3%) were discharged from the ED. An abnormal EEG was found in 98 (71%) of the hospitalised patients and in 183 (59.5%) of those discharged (p=0.019).
Conclusion EEG provides useful diagnostic information and should be considered in all patients presenting to the ED with a seizure. Since the timing of the study affects the diagnostic efficacy of the test, EEG recordings might be done within 24 h either in the ED or epilepsy clinic.
Electroencephalography (EEG) is a technique that has been routinely used for nearly 50 years for the functional exploration of the brain. Although the recent development of newer methods of imagery has limited its clinical indications, it still remains essential for determining a patient's physiological and pathological level of wakefulness. The term 'emergency' for a test means that the results will affect the management and outcome, so these tests should be performed regardless of the time and day. An average response time of 3 h from request to initial reading is acceptable for emergency EEG (eEEG).
Seizures and other clinical conditions mimicking seizures are common in the emergency department (ED) population. However, only a limited amount of the literature on the evaluation and management of seizures comes from the perspective of emergency physicians, and the clinical situations in which an eEEG will be useful have not been unanimously agreed. Local access to neurological and EEG expertise, access to technical personnel and equipment, and local practice patterns limit the performance of EEG in EDs. In a clinical policy statement the American College of Emergency Physicians (ACEP) recommended that EEG should be considered in patients suspected of being in non-convulsive status epilepticus or in subtle convulsive status epilepticus and concluded that no clear recommendation for ordering eEEG in other clinical situations may be made on the basis of available data.
In our hospital the ED and EEG rooms are close and nearly all patients with seizure are consulted in the neurology clinic because of the longer outpatient follow-up times. For almost all patients with seizure the consultant neurologist and emergency physician order an EEG from the ED, and EEG recordings are performed within 1 h in the daytime until 17:00 h. EEGs ordered at night are performed at 08:30 h the following morning, so all EEG reports are obtained in a maximum of 16 h. This retrospective chart review was carried out to identify which clinical conditions meet with the pathological EEG results and to determine the benefits of the positive results on the management of patients.
Abstract and Introduction
Abstract
Background and aim Seizure-related visits are common in the emergency department (ED) but the clinical situations for ordering emergency electroencephalography (EEG) are unclear. The aim of this study is to identify which clinical conditions meet with the pathological EEG and whether patient management is changed by abnormal results.
Methods A retrospective chart review study of all patients visiting the ED with a seizure or symptoms mimicking a seizure was performed. Patients who recorded an EEG within 16 h after the initial event were enrolled. Demographic data and EEG results of patients with provoked and unprovoked seizures were recorded and related factors were analysed.
Results A total of 449 patients (219 men) of mean±SD age of 45.48±21.83 years were evaluated. The seizure was thought to be provoked in 98 patients (21.8%) and unprovoked in 352 (78.2%) patients (31.2% remote symptomatic and 47.4% idiopathic). The EEG results of 281 patients (62.6%) revealed an abnormality, and the abnormal EEG ratio was high in patients with presumed seizure (p<0.001). One hundred and thirty-eight patients (30.7%) were hospitalised and the remainder (n=311, 69.3%) were discharged from the ED. An abnormal EEG was found in 98 (71%) of the hospitalised patients and in 183 (59.5%) of those discharged (p=0.019).
Conclusion EEG provides useful diagnostic information and should be considered in all patients presenting to the ED with a seizure. Since the timing of the study affects the diagnostic efficacy of the test, EEG recordings might be done within 24 h either in the ED or epilepsy clinic.
Introduction
Electroencephalography (EEG) is a technique that has been routinely used for nearly 50 years for the functional exploration of the brain. Although the recent development of newer methods of imagery has limited its clinical indications, it still remains essential for determining a patient's physiological and pathological level of wakefulness. The term 'emergency' for a test means that the results will affect the management and outcome, so these tests should be performed regardless of the time and day. An average response time of 3 h from request to initial reading is acceptable for emergency EEG (eEEG).
Seizures and other clinical conditions mimicking seizures are common in the emergency department (ED) population. However, only a limited amount of the literature on the evaluation and management of seizures comes from the perspective of emergency physicians, and the clinical situations in which an eEEG will be useful have not been unanimously agreed. Local access to neurological and EEG expertise, access to technical personnel and equipment, and local practice patterns limit the performance of EEG in EDs. In a clinical policy statement the American College of Emergency Physicians (ACEP) recommended that EEG should be considered in patients suspected of being in non-convulsive status epilepticus or in subtle convulsive status epilepticus and concluded that no clear recommendation for ordering eEEG in other clinical situations may be made on the basis of available data.
In our hospital the ED and EEG rooms are close and nearly all patients with seizure are consulted in the neurology clinic because of the longer outpatient follow-up times. For almost all patients with seizure the consultant neurologist and emergency physician order an EEG from the ED, and EEG recordings are performed within 1 h in the daytime until 17:00 h. EEGs ordered at night are performed at 08:30 h the following morning, so all EEG reports are obtained in a maximum of 16 h. This retrospective chart review was carried out to identify which clinical conditions meet with the pathological EEG results and to determine the benefits of the positive results on the management of patients.
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