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Abstracts

Ensuring Appropriate Application of Stat EEG: Clinical Insights and Challenges

Abstract number : 1.551
Submission category : 3. Neurophysiology / 3A. Video EEG Epilepsy-Monitoring
Year : 2024
Submission ID : 1470
Source : www.aesnet.org
Presentation date : 12/7/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Michel Abdelmasih, MD – Orlando Health

Christine Ochoa, MD – Orlando Health
Kimberly Kortbein, MHA, BS, REEGT – Orlando Health
Dylan Jessen, REEGT, CLTM – Orlando Health
Dipali Nemade, MD, MPH – Orlando Health

Rationale:
Emergency situations require a rapid and precise diagnostic approach. The exact role and value of stat EEG in emergent situations remain unclear, with limited guidelines on its appropriate use. Stat EEG is primarily used for cases of unexplained altered consciousness where nonconvulsive status epilepticus (NCSE) is suspected. However, frequent inappropriate ordering can overburden the neurodiagnostic team and affect critical care delivery.


Methods:

A retrospective study was conducted on all stat EEGs ordered over four months (October 1, 2023, to January 31, 2024). Standard EEG montages with 20 electrodes were used, recording for 21-24 minutes and including ECG and responses to stimuli. We analyzed data on ordering reasons, requesting specialties, Glasgow Coma Scale scores, neuroimaging findings, and diagnostic impact.



Results:

During the review period, 186 inpatient stat EEGs were performed. Patients ranged from 18 to 92 years old with a male-to-female ratio of approximately 1.264 (59% male, 41% female). Abnormal results were found in 85% (n=159) of all stat EEGs: 65% (n=120) showed diffuse slowing, 11% (n=20) showed focal slowing, 8% (n=15) showed epileptiform discharges, and 2% (n=4) showed status epilepticus or seizures. Regarding neuroimaging, 58% (n=108) of patients had structural brain abnormalities. 85% (n=17) of stat EEGs with focal slowing had a corresponding structural abnormality on brain imaging. Regarding GCS at the time of ordering stat EEG, 46% (n=86) had a GCS of 10 or less and 54% (n=100) had a GCS greater than 10. The most common reason for stat EEG orders was altered mental status, accounting for 45% (n=83). Regarding the specialties ordering stat EEGs, 39% (n=73) were from Critical Care Medicine (CCM), 32% (n=60) from Internal Medicine (IM), 11% (n=20) from Neurology (NEU), 9% (n=16) from Surgical Critical Care (SCC), 6% (n=12) from the Emergency Department (ED), and 3% (n=5) from Neurosurgery (NSG). The rate of finding ictal/interictal discharges per ordering specialty was 25% (n=3) for ED, 20% (n=4) for NEU, 10% (n=7) for CCM, 7% (n=4) for IM, and 6% (n=1) for SCC.



Conclusions:

In our institution, the rate of finding status epilepticus or seizures among stat EEGs is 2%, while the rate of detecting interictal epileptiform discharges is 8%. This study suggests that stat EEGs rarely detect active electrographic seizures.

Proper ordering of stat EEG involves establishing clear criteria and a structured triage process to ensure timely and appropriate use of resources. Stat EEGs should be prioritized for patients with acute unexplained neurological changes such as sudden altered mental status, suspected non-convulsive status epilepticus, or new-onset seizures. By implementing a standardized protocol, we can delineate the specific indications for a stat EEG, ensure necessary clinical information is provided to guide decision-making and optimize resource utilization while enhancing diagnostic accuracy.

Furthermore, a collaborative approach between the requesting physician and the neurodiagnostic team is essential to help manage workload efficiently and optimize patient outcomes.



Funding: None

Neurophysiology