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Electroencephalography in the pediatric emergency department: when is it most useful?
Iván Sánchez Fernández1, Tobias Loddenkemper, Anita Datta
11Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Emergent electroencephalography (EEG) in pediatric emergency departments is most useful for suspected seizures and status epilepticus. EEG results significantly influenced patient disposition, with many children discharged early after ruling out epileptic disturbances.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Neurophysiology
- Neurology
Background:
- Electroencephalography (EEG) is a critical diagnostic tool in pediatric emergency care.
- Determining the specific indications for emergent EEG is essential for optimizing patient management and resource allocation.
Purpose of the Study:
- To identify the key indications for which electroencephalography is most beneficial in the pediatric emergency department.
- To evaluate the impact of emergent EEG results on patient disposition and management decisions.
Main Methods:
- Retrospective review of 70 emergent electroencephalograms performed on 68 pediatric patients.
- Analysis of the influence of EEG findings on patient disposition (admission vs. discharge).
Main Results:
- Emergent EEG was most frequently performed for suspected seizures or status epilepticus (57 cases).
- EEG results influenced the disposition of 13 of 22 discharged children (59.1%), preventing unnecessary admissions.
- Specifically, EEG ruled out epileptic disturbances in 11 children with suspected frequent events and 2 with suspected status epilepticus.
Conclusions:
- Emergent electroencephalography provides crucial clinical information that directly impacts patient disposition in pediatric emergency settings.
- EEG is particularly valuable in clarifying the clinical picture for patients presenting with ongoing events suggestive of seizures or status epilepticus.
Abstract:
This study aimed to identify the indications in which electroencephalography in the pediatric emergency department is most useful. We retrospectively reviewed the influence that the results of the emergent electroencephalogram had on the eventual disposition of patients at our pediatric emergency department. Sixty-eight children (mean age, 7.3 years; 32 males) underwent 70 emergent electroencephalograms. Fifty-seven emergent electroencephalograms were performed for the suspicion of ongoing seizures or status epilepticus. Thirteen of the 22 children (59.1%) discharged from the emergency department were sent home mainly based on the results of the emergent electroencephalogram, which prevented an admission. In particular, 11 of 38 children with frequent and recurrent paroxysmal events concerning for seizures and 2 of 19 children with suspected ongoing status epilepticus were discharged after excluding an epileptic disturbance. The emergent electroencephalogram provided meaningful clinical information that influenced disposition, especially in patients with ongoing events in which the clinical picture was clarified by a rapidly acquired electroencephalogram.
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