Evaluating the Clinical Impact of Rapid Response Electroencephalography: The DECIDE Multicenter Prospective Observational Clinical Study*

Abstract

Objectives: To measure the diagnostic accuracy, timeliness, and ease of use of Ceribell rapid response electroencephalography. We assessed physicians’ diagnostic assessments and treatment plans before and after rapid response electroencephalography assessment. Primary outcomes were changes in physicians’ diagnostic and therapeutic decision making and their confidence in these decisions based on the use of the rapid response electroencephalography system. Secondary outcomes were time to electroencephalography, setup time, ease of use, and quality of electroencephalography data. Design: Prospective multicenter nonrandomized observational study. Setting: ICUs in five academic hospitals in the United States. Subjects: Patients with encephalopathy suspected of having nonconvulsive seizures and physicians evaluating these patients. Interventions: Physician bedside assessment of sonified electroencephalography (30 s from each hemisphere) and visual electroencephalography (60 s) using rapid response electroencephalography. Measurements and Main Results: Physicians (29 fellows or residents, eight attending neurologists) evaluated 181 ICU patients; complete clinical and electroencephalography data were available in 164 patients (average 58.6 ± 18.7 yr old, 45% females). Relying on rapid response electroencephalography information at the bedside improved the sensitivity (95% CI) of physicians’ seizure diagnosis from 77.8% (40.0%, 97.2%) to 100% (66.4%, 100%) and the specificity (95% CI) of their diagnosis from 63.9% (55.8%, 71.4%) to 89% (83.0%, 93.5%). Physicians’ confidence in their own diagnosis and treatment plan were also improved. Time to electroencephalography (median [interquartile range]) was 5 minutes (4–10 min) with rapid response electroencephalography while the conventional electroencephalography was delayed by several hours (median [interquartile range] delay = 239 minutes [134–471 min] [p < 0.0001 using Wilcoxon signed rank test]). The device was rated as easy to use (mean ± sd: 4.7 ± 0.6 [1 = difficult, 5 = easy]) and was without serious adverse effects. Conclusions: Rapid response electroencephalography enabled timely and more accurate assessment of patients in the critical care setting. The use of rapid response electroencephalography may be clinically beneficial in the assessment of patients with high suspicion for nonconvulsive seizures and status epilepticus.

Epileptic seizures in the emergency room: clinical and electroencephalographic findings associated with brain perfusion patterns on computed tomography

“…However, in the present study patients were included if an EEG was performed within 24 h of symptom onset. Thus, probably capturing a more realistic picture of regular delayed conventional EEG performance in many ERs [5]. In addition, longer, continuous EEG recordings in the ER could improve the characterization of patients along the ictal-interictal continuum and its neuroimaging correlate obtained on pCT.…”

“…Stroke and post-ictal epileptic phenomena often mimic SE without prominent motor symptoms (nonconvulsive SE [NCSE]) [4]. In such cases, an electroencephalogram (EEG) is necessary to confirm diagnosis, but even at tertiary hospitals that deal with neurological emergencies, access to EEG can be delayed by 4 h or longer [5]. Seizure duration is one of the main modifiable prognostic factors in SE and reductions in this time are closely correlated with better outcomes [6,7].…”

Noninvasive mobile EEG as a tool for seizure monitoring and management: A systematic review

“…This study also noted that physicians reported using the Rapid‐EEG contributed to changing clinical management and expedited discharge. Vespa et al 38 in a multicenter clinical study Does Use of Rapid Response EEG Impact Clinical Decision Making (DECIDE) trial assessed the impact on physicians’ diagnostic accuracy before and after using the Ceribell system. They found that relying on rapid response EEG information at the bedside improved the sensitivity and specificity of physicians' seizure diagnosis.…”

Monitoring the Burden of Seizures and Highly Epileptiform Patterns in Critical Care with a Novel Machine Learning Method

“…They can rely on their own bedside visual EEG review combined with the Rapid-EEG’s Brain Stethoscope function [ 43 ]. In three clinical studies so far, staff with minimal or no EEG experience increased their accuracy of seizure diagnosis significantly by relying on either Brain Stethoscope alone [ 15 , 16 ] or combined with bedside visual EEG review [ 17 ]. It is important to note that a much larger number of EEG cases often do not result in seizure output, and hence, use of the algorithm will lead to prevention of overtreatment of these cases.…”

“…When actionable EEG interpretations are not immediately available, treatment decisions are made on the basis of clinical suspicion alone, which results in the potential for missing or undertreating some patients with nonconvulsive seizures and overtreating a significantly larger number of patients without seizure activity who may not need aggressive antiseizure medications [ 13 , 14 ]. To provide timely access to EEG, novel rapid EEG systems can be used to enable physicians and allied health professionals to acquire EEG within minutes and stream the data in real time to the cloud, where a machine learning-derived classification algorithm can be applied [ 15 – 17 ].…”