Abstracts

Rationale:
Pediatric status epilepticus carries a high risk of morbidity and mortality and can result in severe neurologic injury. Establishing seizure activity on conventional EEG (cEEG) is essential but can delay treatment of subclinical seizures. cEEG requires technician expertise and equipment whose limited availability can further delay treatment. Rapid response EEG (rrEEG) device Ceribell and its Brain Stethoscope function can be used and interpreted rapidly by bedside providers with minimal training. This retrospective pilot study examines the impact of rrEEG introduction at a quaternary care children’s hospital on time to definitive diagnosis and treatment. The objective of this study was to compare the time to determination of electrographic activity (TDEA) between cEEG and rrEEG. Secondary outcomes were EEG setup time, accuracy of the Brain Stethoscope, and changes in clinical decision-making.

Methods:
This was a single center retrospective observational cohort study that analyzed data from patients 2-18 years old who presented to the PICU and pediatric ER with concern for status epilepticus. All EEG waveform data in both cohorts was interpreted by a board-certified epileptologist. Full montage EEG and rrEEG were both offered 24/7 at our institution, with the caveat that the patient be placed on cEEG if it could be read within 60 minutes of initiation. For rrEEG patients, the bedside physician used the Brain Stethoscope at four discrete points. TDEA and setup time were recorded and compared using Welch’s T-test. Diagnostic specificity and sensitivity for status epilepticus using the Brain Stethoscope were calculated with the epileptologist assessment as the gold standard.

Results:
Data was collected from fifteen pediatric patients on rrEEG and fifteen patients on cEEG. When compared to cEEG, rrEEG decreased TDEA (132 ± 54 min vs 22 ± 7 min, p=.000002) and had a shorter setup time (22 ± 5 min vs 9 ± 6 min, p=0.0000004). Bedside physicians diagnosed electrographic activity using the Brain Stethoscope with 100% sensitivity (95% CI 63% to 100%) and 92 % specificity (95% CI 81% to 97%). Rapid response EEG ruled out status epilepticus in twelve patients and changed physician clinical decision-making in six patients.

Conclusions:
Rapid response EEG allowed for earlier diagnosis of brain electrographic activity in pediatric patients when compared to cEEG. Despite 24/7 technician and epileptologist coverage, there was a significant delay to diagnosis when using the cEEG. Rapid response EEG allowed for the bedside provider to initiate EEG monitoring, successfully diagnose patients using the Brain Stethoscope, and decrease delays associated with technician availability. In this single pediatric epilepsy center, the rrEEG had the potential to reduce EEG set-up related costs by over $100K per year. More importantly, this promising rrEEG technology can facilitate faster assessment of status epilepticus in pediatric patients in ICU and ER settings and enhance patient safety and quality of care by potentially reducing ongoing neurologic injury.

Funding:
This study received funding from the Department of Pediatrics of the Icahn School of Medicine at Mount Sinai.