TY - JOUR
T1 - Emergent EEG in the emergency department in patients with altered mental states
AU - Ziai, Wendy C.
AU - Schlattman, Dan
AU - Llinas, Rafael
AU - Venkatesha, Santosh
AU - Truesdale, Melvin
AU - Schevchenko, Anastasia
AU - Kaplan, Peter W.
N1 - Funding Information:
This work was supported by a Research Grant from the Epilepsy Foundation . This publication was also supported by a subcontract from Infinite Biomedical Technologies, LLC (“IBT”). Dr. Ziai has received support from the Epilepsy Foundation, and has served in an editorial capacity for Current Opinion in Neurology. Dan Schlattman also received support from the Epilepsy Foundation. Santosh Venkatesha, Dan Schlattman, and Peter Kaplan have all also received support from NIH Grant U44 NS057966-01. The remaining authors have no conflicts of interest.
PY - 2012/5
Y1 - 2012/5
N2 - Objective: To evaluate whether EEG performed within 30. min of referral by an ED physician helps establish diagnosis and/or changes management and in which clinical setting. Methods: Single-center prospective cohort intervention study 1. day/week, of sequentially referred adult patients with clinical seizures or altered mental status (AMS). Standard EEGs were performed by an EEG technician using a commercially available cap, interpreted by an epileptologist, immediately reported to the ED physician and a utility survey completed. Quality and interpretation of 20. min EEGs was compared to pre-specified 5. min segments of each EEG using the kappa coefficient. Results: Over 1. year, 82 patients underwent ED EEG. Tonic clonic seizure activity had occurred in 33%. Mean time for EEG setup was 13.1 ± 6.2. min. EEG assisted the diagnosis in 51%, changed ED management in 4% and would be ordered again if EEG was available in 46%. Positive utility of EEG was significantly associated with toxicologic, psychiatric and endocrine/metabolic causes of AMS vs. other causes (p< 0.001) and sudden onset AMS (p= 0.007). Independent predictors of whether ED EEG would be ordered if available were witnessed seizures (p= 0.01), no prior head trauma (p= 0.001) and survey respondent being a physician assistant (vs. MD) (p= 0.02). The 5 (vs. 20) min EEG presented good agreement on waveform shape/amplitude (kappa = 0.78), artifact (kappa = 0.75) and interpretation categories (all kappa levels ≥0.70). Conclusions: Rapid availability of standard full-montage EEG in the ED is feasible and helps establish a diagnosis in about half of AMS patients, but rarely changes management. An abbreviated 5. min full-montage EEG presents adequate reliability which may improve use in the ED. Significance: Specific presentations of AMS offer the best diagnostic benefit for EEG in the ED.
AB - Objective: To evaluate whether EEG performed within 30. min of referral by an ED physician helps establish diagnosis and/or changes management and in which clinical setting. Methods: Single-center prospective cohort intervention study 1. day/week, of sequentially referred adult patients with clinical seizures or altered mental status (AMS). Standard EEGs were performed by an EEG technician using a commercially available cap, interpreted by an epileptologist, immediately reported to the ED physician and a utility survey completed. Quality and interpretation of 20. min EEGs was compared to pre-specified 5. min segments of each EEG using the kappa coefficient. Results: Over 1. year, 82 patients underwent ED EEG. Tonic clonic seizure activity had occurred in 33%. Mean time for EEG setup was 13.1 ± 6.2. min. EEG assisted the diagnosis in 51%, changed ED management in 4% and would be ordered again if EEG was available in 46%. Positive utility of EEG was significantly associated with toxicologic, psychiatric and endocrine/metabolic causes of AMS vs. other causes (p< 0.001) and sudden onset AMS (p= 0.007). Independent predictors of whether ED EEG would be ordered if available were witnessed seizures (p= 0.01), no prior head trauma (p= 0.001) and survey respondent being a physician assistant (vs. MD) (p= 0.02). The 5 (vs. 20) min EEG presented good agreement on waveform shape/amplitude (kappa = 0.78), artifact (kappa = 0.75) and interpretation categories (all kappa levels ≥0.70). Conclusions: Rapid availability of standard full-montage EEG in the ED is feasible and helps establish a diagnosis in about half of AMS patients, but rarely changes management. An abbreviated 5. min full-montage EEG presents adequate reliability which may improve use in the ED. Significance: Specific presentations of AMS offer the best diagnostic benefit for EEG in the ED.
KW - Consciousness disorders
KW - Electroencephalogram
KW - Emergency service/hospital
KW - Seizures
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U2 - 10.1016/j.clinph.2011.07.053
DO - 10.1016/j.clinph.2011.07.053
M3 - Article
C2 - 21978652
AN - SCOPUS:84858753831
SN - 1388-2457
VL - 123
SP - 910
EP - 917
JO - Clinical Neurophysiology
JF - Clinical Neurophysiology
IS - 5
ER -