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Utility of electroencephalography in the pediatric emergency department
F K Alehan1, L D Morton, J M Pellock
1Division of Child Neurology, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0211, USA.
Insights
Electroencephalography (EEG) is crucial in pediatric emergency departments for diagnosing seizures. An abnormal EEG in children with new-onset seizures indicates a higher recurrence risk and aids diagnosis in 84% of cases.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Electroencephalography (EEG) is a key diagnostic tool in neurology.
- Its utility in the pediatric emergency department (PED) setting requires specific evaluation.
- Seizure disorders and altered mental states are common pediatric emergencies.
Purpose of the Study:
- To evaluate the diagnostic role and impact of EEG in a pediatric emergency department.
- To analyze EEG findings in relation to clinical presentation and outcomes.
- To determine the effectiveness of EEG in diagnosing seizure disorders in children.
Main Methods:
- Retrospective review of pediatric patients undergoing EEG in the PED between 1995-1997.
- Categorization of patients into three groups based on clinical presentation: new-onset seizures, worsening epilepsy with altered mentation, and acute confusional states.
- Analysis of EEG results, clinical data, and follow-up information.
Main Results:
- Of 57 EEGs in 56 patients, 55.6% of new-onset seizures (n=36) showed abnormal findings.
- Abnormal EEGs in new-onset seizures correlated with a significantly higher risk of recurrence (80% vs. 31%).
- EEG directly contributed to diagnosis in 84% of PED referrals, identifying seizure disorders or ruling out seizures.
Conclusions:
- Prompt EEG is valuable in the pediatric emergency department for children with new-onset seizures.
- EEG is essential for diagnosing nonconvulsive status epilepticus and guiding treatment.
- Consider EEG for pediatric patients with unexplained altered consciousness to rule out seizure activity.
Abstract:
To assess the role of electroencephalography (EEG) in the pediatric emergency department, we reviewed the records of all patients having an EEG in the pediatric emergency department of our hospital between 1995 and 1997. EEG findings, clinical presentations, and follow-up data were analyzed, and patients were distributed into three groups according to clinical presentation: group 1 included patients with new-onset seizures, group 2 included patients with known epilepsy presenting with worsening seizures and altered mentation, and group 3 comprised patients with acute confusional states. Overall, 56 patients with 57 EEGs were included. In group 1 (n = 36), 20 (55.6%) had an abnormal EEG. The risk of recurrence was much higher in children with abnormal EEGs (80% vs. 31%) (P < .01). In retrospect, among all of the patients receiving the diagnosis of epilepsy, 76% had an abnormal emergency department EEG. Four in group 2 (n = 14) and one in group 3 (n = 7) were proven to have nonconvulsive status epilepticus and were treated accordingly. No patients in group 1 had nonconvulsive status epilepticus. Ongoing seizures were promptly excluded in the remainder. The EEG directly contributed to the diagnosis in 84% of all referrals in the pediatric emergency department, either being abnormal and leading to a diagnosis of a seizure disorder or confirming low suspicion for seizures. Thus, a prompt EEG should be considered in children with new-onset seizures and unexplained altered consciousness.