Point‐of‐care electroencephalography enables rapid evaluation and management of non‐convulsive seizures and status epilepticus in the emergency department
Abstract Objectives To describe our institutional experience with point‐of‐care electroencephalography (pocEEG) and its impact on the evaluation/management of suspected non‐convulsive seizures in the emergency department (ED). Methods We retrospectively identified 157 adults who underwent pocEEG mon...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.13004 |
| _version_ | 1797737272958779392 |
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| author | Richard Kozak Kapil Gururangan Parshaw J. Dorriz Matthew Kaplan |
| author_facet | Richard Kozak Kapil Gururangan Parshaw J. Dorriz Matthew Kaplan |
| author_sort | Richard Kozak |
| collection | DOAJ |
| description | Abstract Objectives To describe our institutional experience with point‐of‐care electroencephalography (pocEEG) and its impact on the evaluation/management of suspected non‐convulsive seizures in the emergency department (ED). Methods We retrospectively identified 157 adults who underwent pocEEG monitoring in our community hospital ED in 1 year. We calculated the time to obtain pocEEG in the ED (door‐to‐EEG time) and examined the impact of pocEEG findings (categorized as seizure, highly epileptiform patterns, slowing, or normal activity) on antiseizure medication treatment. Results PocEEG revealed seizures (14%, n = 22), highly epileptiform patterns (22%, n = 34), slowing (44%, n = 69), and normal activity (20%, n = 32). The median door‐to‐EEG time (from initial ED evaluation to pocEEG monitoring) was only 1.2 hours (interquartile range 0.1–2.1) even though 55% of studies were performed after‐hours (5 pm–9 am). Most patients were admitted (54% to the intensive care unit, 41% to floor). Antiseizure medication treatment occurred pre‐pocEEG in 93 patients (59%) and post‐pocEEG in 88 patients (56%). By reviewing the relationship between pocEEG monitoring and antiseizure medication management, we found a significant association between pocEEG findings and changes in management (P < 0.001). Treatment escalation occurred more frequently in patients with epileptiform activity (seizures or highly epileptiform patterns, 52%) than patients with non‐epileptiform activity (normal or slow, 25%, P < 0.001), and avoidance of treatment escalation occurred more frequently in patients with normal or slow activity (27%) than patients with seizures or highly epileptiform patterns (2%, P < 0.001). Conclusion Our study, the largest to date describing the real‐world use of pocEEG in emergency medicine, found that rapid EEG acquisition in the ED was feasible in a community hospital and significantly affected the management of suspected non‐convulsive seizures. |
| first_indexed | 2024-03-12T13:26:16Z |
| format | Article |
| id | doaj.art-3b4870ad8c7a4027bf28e5edda1c6a87 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-03-12T13:26:16Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-3b4870ad8c7a4027bf28e5edda1c6a872023-08-25T05:44:31ZengWileyJournal of the American College of Emergency Physicians Open2688-11522023-08-0144n/an/a10.1002/emp2.13004Point‐of‐care electroencephalography enables rapid evaluation and management of non‐convulsive seizures and status epilepticus in the emergency departmentRichard Kozak0Kapil Gururangan1Parshaw J. Dorriz2Matthew Kaplan3Department of Emergency Medicine Providence Mission Medical Center Mission ViejoCaliforniaUSADepartment of Neurology David Geffen School of Medicine at UCLA Los AngelesCaliforniaUSADepartment of Neurology Providence Mission Medical Center Mission ViejoCaliforniaUSADepartment of Emergency Medicine Providence Mission Medical Center Mission ViejoCaliforniaUSAAbstract Objectives To describe our institutional experience with point‐of‐care electroencephalography (pocEEG) and its impact on the evaluation/management of suspected non‐convulsive seizures in the emergency department (ED). Methods We retrospectively identified 157 adults who underwent pocEEG monitoring in our community hospital ED in 1 year. We calculated the time to obtain pocEEG in the ED (door‐to‐EEG time) and examined the impact of pocEEG findings (categorized as seizure, highly epileptiform patterns, slowing, or normal activity) on antiseizure medication treatment. Results PocEEG revealed seizures (14%, n = 22), highly epileptiform patterns (22%, n = 34), slowing (44%, n = 69), and normal activity (20%, n = 32). The median door‐to‐EEG time (from initial ED evaluation to pocEEG monitoring) was only 1.2 hours (interquartile range 0.1–2.1) even though 55% of studies were performed after‐hours (5 pm–9 am). Most patients were admitted (54% to the intensive care unit, 41% to floor). Antiseizure medication treatment occurred pre‐pocEEG in 93 patients (59%) and post‐pocEEG in 88 patients (56%). By reviewing the relationship between pocEEG monitoring and antiseizure medication management, we found a significant association between pocEEG findings and changes in management (P < 0.001). Treatment escalation occurred more frequently in patients with epileptiform activity (seizures or highly epileptiform patterns, 52%) than patients with non‐epileptiform activity (normal or slow, 25%, P < 0.001), and avoidance of treatment escalation occurred more frequently in patients with normal or slow activity (27%) than patients with seizures or highly epileptiform patterns (2%, P < 0.001). Conclusion Our study, the largest to date describing the real‐world use of pocEEG in emergency medicine, found that rapid EEG acquisition in the ED was feasible in a community hospital and significantly affected the management of suspected non‐convulsive seizures.https://doi.org/10.1002/emp2.13004emergency medicineneuro‐emergenciesnon‐convulsive seizurepoint‐of‐care electroencephalographystatus epilepticus |
| spellingShingle | Richard Kozak Kapil Gururangan Parshaw J. Dorriz Matthew Kaplan Point‐of‐care electroencephalography enables rapid evaluation and management of non‐convulsive seizures and status epilepticus in the emergency department Journal of the American College of Emergency Physicians Open emergency medicine neuro‐emergencies non‐convulsive seizure point‐of‐care electroencephalography status epilepticus |
| title | Point‐of‐care electroencephalography enables rapid evaluation and management of non‐convulsive seizures and status epilepticus in the emergency department |
| title_full | Point‐of‐care electroencephalography enables rapid evaluation and management of non‐convulsive seizures and status epilepticus in the emergency department |
| title_fullStr | Point‐of‐care electroencephalography enables rapid evaluation and management of non‐convulsive seizures and status epilepticus in the emergency department |
| title_full_unstemmed | Point‐of‐care electroencephalography enables rapid evaluation and management of non‐convulsive seizures and status epilepticus in the emergency department |
| title_short | Point‐of‐care electroencephalography enables rapid evaluation and management of non‐convulsive seizures and status epilepticus in the emergency department |
| title_sort | point of care electroencephalography enables rapid evaluation and management of non convulsive seizures and status epilepticus in the emergency department |
| topic | emergency medicine neuro‐emergencies non‐convulsive seizure point‐of‐care electroencephalography status epilepticus |
| url | https://doi.org/10.1002/emp2.13004 |
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