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Continuous or emergent EEG: can bedside caregivers recognize epileptiform discharges?
Enrique C Leira1, Mary E Bertrand2, R Edward Hogan2
1Souers Stroke Institute, Department of Neurology, Saint Louis University, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA. leiraec@slu.edu.
Intensive Care Medicine
|November 15, 2003
Summary
Nonexpert bedside caregivers have low accuracy in recognizing epileptiform discharges on EEG. A brief educational intervention showed only a modest improvement, highlighting the need for trained personnel, like EEG technicians, for interpreting emergent EEG recordings.
Area of Science:
- Neuroscience
- Clinical Neurology
- Medical Education
Background:
- Emergent or continuous electroencephalogram (EEG) monitoring is crucial for detecting subclinical seizures.
- Expert interpretation of EEG results is often delayed in critical care settings.
- The ability of nonexpert bedside caregivers to recognize epileptiform discharges is largely unassessed.
Purpose of the Study:
- To evaluate the proficiency of various nonexpert bedside caregivers in identifying epileptiform discharges on EEG.
- To determine if a simple educational intervention can enhance this skill.
Main Methods:
- A prospective cohort study was conducted at a tertiary medical center.
- Participants included neurology/neurosurgery residents, fellows, nurses, and EEG technicians.
- A computer-based PowerPoint lecture served as the educational intervention, with pre- and post-testing of EEG interpretation skills.
Main Results:
- Caregiver accuracy in identifying epileptiform discharges varied significantly, from 46% (medical critical care nurses) to 94% (EEG technicians).
- The overall mean correct response rate improved from 61% in the pre-test to 67% in the post-test (p=0.002).
- The educational intervention resulted in a modest improvement in recognition ability across groups.
Conclusions:
- Bedside caregivers demonstrate a concerningly low ability to recognize epileptiform discharges on EEG.
- A simple educational intervention provides only marginal improvement in this skill.
- Reliance on untrained personnel for interpreting emergent EEG is not advisable; EEG technicians are a notable exception and should be utilized.