Screening electroencephalograms are feasible in the emergency department

Abstract

We investigated the feasibility and quality of a wireless, four-channel screening electroencephalogram (EEG) device on patients presenting to the emergency department (ED) with a possible seizure disorder. A convenience sample was used of ED patients presenting with a preliminary diagnosis of syncope, potential partial-complex or generalized seizure disorder, head injury with prolonged symptoms or acute undiagnosed altered mental status. Study patients had a screening EEG in the ED, but the emergency physician and patient were blinded to the results of the EEG so that neither patient care nor disposition were affected by inclusion in the study. A total of 227 patients were enrolled, with a mean age of 56 years. EEG quality was acceptable, i.e. a screening interpretation was able to be provided, in 208 of 227 cases (92%). The EEG interpretation was normal in 65%, identified generalized or focal slowing in 24% and identified sub-clinical epileptiform activity in 12% of patients. Screening EEGs performed in the ED are feasible, can be acquired with acceptable quality, and may identify sub-clinical seizure activity in a significant number of patients.

StatNet Electroencephalogram: A Fast and Reliable Option to Diagnose Nonconvulsive Status Epilepticus in Emergency Setting

“…They reported that 11% of stat EEGs showed NCSE. With similar findings, Alroughani 5 described a rate of 9% in patients with unknown cause of impaired level of consciousness, and Bastani et al 22 described subclinical epileptiform activity in 12% of patients studied with a screening EEG device in the ED. More recently, Brenner et al 23 found nonconvulsive seizure activity in 8% of patients when comparing a portable six-lead Brainmaster EEG device with conventional EEG.…”

Interfacility Transfers for Seizure-Related Emergencies in the United States

“…As such, this may represent an opportunity to thoughtfully deploy newly developed rapid-EEG systems that require less local technical knowledge and can be integrated with teleneurology tools for remote emergent interpretation in the acute emergency setting. 3,[6][7][8][9][23][24][25][26] The association between EEG availability, rurality, and hospital transfers echoes earlier studies of rural-to-urban ED transfer for CT imaging. 27,28 These studies of transfers from rural EDs in a single-payer (Canadian) health care system identified lack of CT availability as common, intervenable and possible cost-effective method of decreasing transfers.…”

“…Therefore, improving access to screening EEG or tele-EEG appears to be a highly actionable area for optimizing triage among nonmetropolitan, low-seizure volume EDs with high transfer rates. 3,6,8,[23][24][25] Importantly, cEEG capability involves not only the availability of equipment and technical expertise but also access to epilepsy providers for EEG interpretation, which may be limited especially in rural areas. As such, this may represent an opportunity to thoughtfully deploy newly developed rapid-EEG systems that require less local technical knowledge and can be integrated with teleneurology tools for remote emergent interpretation in the acute emergency setting.…”

“…As such, this may represent an opportunity to thoughtfully deploy newly developed rapid-EEG systems that require less local technical knowledge and can be integrated with teleneurology tools for remote emergent interpretation in the acute emergency setting. 3,6-9,23-26…”

Midline and Parasagittal Seizures are Rare in Adult Patients

“…Multiple devices have been studied to adapt the traditional EEG infrastructure to more effectively meet the clinical needs of these emergent situations [3][4][5]. Such devices have frequently utilized fewer EEG electrodes to simplify and speed their application to the patient's scalp.…”