EEG use in a tertiary referral centre.

Area of Science:

• Clinical Neurophysiology
• Medical Auditing

Background:

• Electroencephalograms (EEGs) are crucial diagnostic tools in neurology.
• Guidelines from SIGN and NICE exist to ensure appropriate EEG utilization.
• Previous audits have highlighted variability in EEG request appropriateness.

Purpose of the Study:

• To retrospectively audit the appropriateness and yield of electroencephalograms (EEGs) performed at Cork University Hospital.
• To assess the adherence to SIGN and NICE guidelines for EEG requests.
• To identify patterns of inappropriate EEG utilization, particularly for specific symptoms.

Main Methods:

• Retrospective audit of all EEGs conducted over a 2-month period in 2009.
• Review of 316 EEG records from the Neurophysiology Department.
• Classification of EEG requests as 'appropriate' or 'inappropriate' based on SIGN and NICE guidelines.
• Analysis of EEG results, including abnormalities and epileptiform features.

Main Results:

• A total of 316 EEGs were performed; 56% were completed within 24 hours.
• 66% of EEGs were deemed appropriate, with 38% of these showing abnormalities (28 with epileptiform features).
• 34% of EEG requests were inappropriate, yielding abnormalities in only 14% of cases.
• EEGs for syncope/funny turns (21% of total) showed no epileptiform abnormalities.

Conclusions:

• EEGs are frequently over-requested at the institution, especially for syncope and 'funny turns'.
• The low yield from EEGs in certain patient cohorts, like those with syncope, indicates potential for improved diagnostic stewardship.
• Recommendations for refining EEG request criteria and improving resource allocation are suggested.