Authors :
Presenting Author: Naomi Niznick, MD – The Ottawa Hospital
Julie Kromm, MD – Foothills Medical Hospital, Universit of Calgary
Jay Gavvala, MD – UT Health Houston
Marcus Ng, MD – University of Manitoba
Victoria McCredie, MD – UHN
TAdeu Fantaneanu, MD – The Ottawa Hospital, University of Ottawa
Rationale:
cEEG is the gold standard for diagnosing non-convulsive seizures and non-convulsive status epilepticus (NCSE) in the ICU, with NCSE occurring in 8-10% of patients with unexplained coma. Untreated NCSE is associated with increased mortality, and continuous electroencephalogram (cEEG) monitoring allows clinicians to identify more than double the number of seizures captured during a 30-minute routine EEG recording.
Previous studies have shown significant variability in how cEEG monitoring is performed in ICUs worldwide. There is currently very limited data outlining cEEG practice in Canadian hospitals owing in part to fragmented provincial health authority data and the lack of a centralized data collection method. We aimed to understand the availability, indications, and barriers to cEEG access in.
Methods:
We conducted a cross-sectional survey of medical EEG laboratory directors at Canadian adult hospitals. The bilingual survey was modified from a previously developed study, which was initially disseminated to institutions in the United States to assess the use of continuous EEG monitoring1. The final survey consisted of 4 sections, focusing on: Practitioner Information; Institution Information; Continuous EEG Monitoring Indications & Technical Aspects. Pre-testing and clinical sensibility testing was completed prior to dissemination.
The survey was distributed online to all medical lab directors of adult institutions with an EEG laboratory and where cEEG (defined as 4 hours minimum of continuous video EEG recording outside of an EMU setting) was deemed to be supported.
Results:
Out of 1280 adult Canadian Hospitals, only 92 hospital networks were identified as having an EEG laboratory (7.1%). Out of 92 identified hospitals networks servicing 122 campuses, 24 were identified as possibly having the infrastructure for cEEG (26%). Of these, 21/24 sites responded to the survey (response rate 88%). 18 of the surveyed hospital networks had cEEG availability (86%), and out of 22 Canadian tertiary hospital networks, only 14 had cEEG availability (64%).
Only 28% had an institutional guideline outlining indications for cEEG. Other than seizure detection, the primary indications were primarily for spell characterization (100%) and post cardiac arrest neuroprognosication (50%), while only 17% of centers had an indication for ischemia monitoring.
No center had an on-site technologist available 24/7 however 28% had an on-call technologist 24/7. Only 22% of centers had access to quantitative EEG, with only 1 center having access to Persyst software.
Conclusions:
There is a lack of EEG laboratory and cEEG-specific access across Canadian healthcare including at major tertiary care centers. Most Canadian hospitals do not meet the standards set by guidelines on the use of cEEG. This lack of access is concerning and requires a major rethink of this potentially lifesaving technology.
Funding: nil