Evaluating the utility of Rapid Response EEG in emergency care

Abstract

BackgroundTimely management of non-convulsive status epilepticus (NCSE) is critical to improving patient outcomes. However, NCSE can only be confirmed using electroencephalography (EEG), which is either significantly delayed or entirely unavailable in emergency departments (EDs). We piloted the use of a new bedside EEG device, Rapid Response EEG (Rapid-EEG, Ceribell), in the ED and evaluated its impact on seizure management when used by emergency physicians.MethodsPatients who underwent Rapid-EEG to rule out NCSE were prospectively enrolled in a pilot project conducted at two ED sites (an academic hospital and a community hospital). Physicians were surveyed on the perceived impact of the device on seizure treatment and patient disposition, and we calculated physicians’ sensitivity and specificity (with 95% CI) for diagnosing NCSE using Rapid-EEG’s Brain Stethoscope function.ResultsOf the 38 patients enrolled, the one patient with NCSE was successfully diagnosed and treated within minutes of evaluation. Physicians reported that Rapid-EEG changed clinical management for 20 patients (53%, 95% CI 37% to 68%), primarily by ruling out seizures and avoiding antiseizure treatment escalation, and expedited disposition for 8 patients (21%, 95% CI 11% to 36%). At the community site, physicians diagnosed seizures by their sound using Brain Stethoscope with 100% sensitivity (95% CI 5% to 100%) and 92% specificity (95% CI 62% to 100%).ConclusionRapid-EEG was successfully deployed by emergency physicians at academic and community hospitals, and the device changed management in a majority of cases. Widespread adoption of Rapid-EEG may lead to earlier diagnosis of NCSE, reduced unnecessary treatment and expedited disposition of seizure mimics.

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

“…Multiple quality metrics were compared between Rapid‐EEG and a conventional EEG performed immediately afterwards, showing no statistical difference between all metrics except for the power of 60 Hz noise. Wright et al 37 similarly showed that of 38 patients wearing the Ceribell in the ICU, the one patient with NCSE was successfully diagnosed. This study also noted that physicians reported using the Rapid‐EEG contributed to changing clinical management and expedited discharge.…”

Adult Critical Care Electroencephalography Monitoring for Seizures: A Narrative Review

“…Time to EEG placement was a median of 5 min with the rapid response system vs. 239 min with conventional EEG (11). Furthermore, this rapid response modality may be economically feasible for both resource limited and rich regions but requires further investigation (35).…”

Rapid Response EEG: Current State and Future Directions

“…In a prospective pilot study of 38 emergency department patients, staff and physicians placed Ceribell® rEEG (RRLM-EEG, rapid response limited montage EEG), and the on-call trained neurologist analyzed the recordings and provided the results [ 4 ••]. One patient was diagnosed with NCSE and received antiseizure medications.…”

“…When compared with neurologists, authors reported high sensitivity (100%) and specificity (93%) when evaluating EEG with > 90% seizure burden in status epilepticus. Emergency physicians reported 100% sensitivity and 92% specificity in assessing suspected seizures using the Brain Stethoscope function [ 4 ••]. Sanz-García et al observed a better correlation of the depth of sedation with EEG feature using a machine learning approach than with traditional bispectral index systems in the ICU [ 14 ].…”