Feasibility and usefulness of rapid 2-channel-EEG-monitoring (point-of-care EEG) for acute CNS disorders in the paediatric emergency department: an observational study

Abstract

IntroductionThe aim of this study was to determine the feasibility and clinical utility of point-of-care electroencephalogram (pocEEG) in the paediatric emergency department (ED) for children presenting with acute non-traumatic central nervous system (CNS) disorders.MethodsRetrospective observational study of prospectively collected data in paediatric patients (0–16 years) with acute non-traumatic CNS-disorders presenting between April 2014 and February 2017 to a single paediatric ED in Switzerland.The 2-channel EEG was applied to all patients presenting with acute seizures or impaired consciousness to the ED. For a pocEEG, scalp surface electrodes are applied in five locations, thus allowing registration of fronto-temporal bilateral cortical activity. Neurology consultants assisted with interpretation of readings. EEG findings and clinical characteristics were collected. Feasibility and usefulness were rated via Likert scale.Results36 patients with acute seizures or altered mental status were analysed. Age range was 9 months to 15 years, median age of 34 months. 21 of 36 (58%) patients arrived out of hours. Application of electrodes was rated as ‘easy’ in 28 (77.8%) patients and rated as ‘difficult’ in 8 (22.2%). The utility of the EEG was rated by physicians as ‘very useful/diagnostic’ in 13 cases (36%), ‘useful’ in 21 cases (58%), ‘not useful’ in two cases (8%). None were rated ‘negative.’ConclusionUptake of pocEEG introduction has been very encouraging. Provider ratings were overwhelmingly positive. Recognition of non-convulsive status epilepticus was improved and pocEEG facilitated more targeted interventions.

Benzodiazepine Use for Pediatric Patients With Suspected Nonconvulsive Status Epilepticus With or Without Simplified Electroencephalogram

“…36 In addition, studies demonstrated the feasibility of EEG with reduced number of electrodes for the detection of NCSE in emergency outpatient adults and pediatric patients with altered consciousness. 9,37 Therefore, the reported reliability of sEEG in previous studies lend support for its validity in the current study population.…”

“…Few studies have examined the validity of sEEG in pediatric patients; however, a study on neonatal patients reported that the sensitivity and sensitivity of single-pole induced EEG with reduced electrodes for detecting brain-wave abnormalities were 94% and 78%, respectively, which were comparable with those of standard EEG 36 . In addition, studies demonstrated the feasibility of EEG with reduced number of electrodes for the detection of NCSE in emergency outpatient adults and pediatric patients with altered consciousness 9,37 . Therefore, the reported reliability of sEEG in previous studies lend support for its validity in the current study population.…”

Rapid Response EEG: Current State and Future Directions

“…When compared to 104.5 min using a conventional EEG, significant time savings were seen with the EEG cap, which has a median “time to cap” EEG recording of 22.5 min. In summary, as shown in the current studies, rapid diagnosis of NCSE or other diagnoses supported using EEG in the future can be made quicker by wearables [ 21 ].…”

“…Simma et al demonstrated that NCSE was identified in six out of 36 patients in a convenience sample, using a limited 2-electrode point-of-care EEG system applied by emergency nurses and interpreted by emergency physicians with the assistance of remote pediatric neurology consultants [ 21 ].…”

Integrating Neuromonitoring in Pediatric Emergency Medicine: Exploring Two Options for Point-of-Care Electroencephalogram (pocEEG) via Patient Monitors—A Technical Note

“…A simplified EEG performed at the bedside in the ED has been shown to complement clinical, laboratory, and imaging assessment and aid patient management [ 15 , 16 ]. A pocEEG has proven useful for evaluating altered mental status, detecting NCSE, and monitoring the treatment of ongoing SE [ 17 ]. In a retrospective pediatric cohort, 41/242 (17%) patients with altered mental status were diagnosed with non-convulsive seizures in pocEEG.…”