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Paediatric electroencephalograph: The benefits of guidelines
Brooke E Thompson Nee Milner1, David Newsom1, Andrew White1,2
1Department of Paediatrics, Townsville Hospital, Townsville, Queensland, Australia.
Insights
Implementing National Institute for Health and Care Excellence (NICE) guidelines for pediatric electroencephalogram (EEG) tests reduced unnecessary investigations and improved the speed of obtaining results. This highlights the value of clinical guidelines in optimizing diagnostic practices.
Area of Science:
- Pediatric Neurology
- Clinical Practice Guidelines
- Diagnostic Imaging
Background:
- Electroencephalogram (EEG) is a crucial diagnostic tool for childhood paroxysmal events but is frequently overutilized.
- National Institute for Health and Care Excellence (NICE) guidelines exist to aid clinicians in appropriate EEG ordering for pediatric epilepsy evaluations.
Purpose of the Study:
- To assess if implementing NICE epilepsy guidelines in a hospital setting alters clinician ordering practices for pediatric EEGs.
- To determine if guideline introduction reduces unnecessary EEG tests and improves the timeliness of EEG acquisition.
Main Methods:
- A retrospective review of pediatric EEG requests, results, and patient charts was conducted before and after introducing an EEG request form with NICE guideline-based ordering advice.
- Data analyzed included patient demographics, clinical indications, and the time from EEG order to performance.
Main Results:
- The proportion of EEG requests meeting NICE criteria increased from 56% to 83% after guideline implementation.
- EEGs ordered per guidelines showed a higher abnormality rate (61%) compared to those outside guidelines (4%).
- Despite low form usage (29%), guideline adherence improved, reducing test volume and turnaround times.
Conclusions:
- The study demonstrates that incorporating clinical guidelines effectively improves the timeliness and reduces the overutilization of EEGs in general pediatric practice.
- Guideline implementation, even with suboptimal form adherence, leads to more appropriate test ordering and faster diagnostic processes.
Aim:
The electroencephalogram (EEG) is an important but often over-relied upon investigation in evaluating paroxysmal events of childhood. The UK National Institute for Health and Care Excellence (NICE) guidelines for epilepsy help clinicians decide which children should/should not have an EEG. Would introduction of these guidelines in our hospital change the ordering practices of our hospital clinicians? Would introduction reduce unnecessary tests and improve rapidity of obtaining an EEG?
Methods:
Paediatric EEG requests, results and, where possible, the patient hospital chart were reviewed before and after introduction of an EEG request form (Appendix I) which provided ordering advice as per the NICE epilepsy guideline. Patient age, sex, distance from hospital and ethnicity were reviewed. Also evaluated was clinical indication and time from ordering to performing the EEG.
Results:
Prior to the new EEG form, 56% of the EEG requests fulfilled the NICE criteria; after its introduction, this increased to 83%. EEGs ordered within the NICE guidelines were abnormal on 61% of occasions, but when ordered outside of the guidelines they were abnormal only 4% of the time (P < 0.0001). After its introduction there was poor use of the new form in practice (only 29% of requests). However, the EEGs were more likely to meet ordering criteria and fewer tests were required, leading to more rapid turn-around times.
Conclusion:
This study demonstrates the value of using guidelines to improve timeliness and reduce over-utilisation of EEGs in general paediatric practice.
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