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Electroencephalography Quality and Application Times in a Pediatric Emergency Department Setting: A Feasibility Study
Carol M Stephens1, Sean R Mathieson1, Brian McNamara2
1INFANT Research Centre, University College Cork, Cork, Ireland; Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
Insights
Pediatric electroencephalography (EEG) is feasible in emergency departments for diagnosing status epilepticus. Good-quality EEG recordings can be obtained within an hour, aiding in timely diagnosis and treatment of neurological emergencies in children.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Neurophysiology
Background:
- Status epilepticus is a common pediatric neurological emergency.
- Diagnosing nonconvulsive status epilepticus is challenging and requires electroencephalographic (EEG) confirmation.
- Rapid EEG acquisition in emergency settings is crucial for timely diagnosis.
Purpose of the Study:
- To assess the feasibility of obtaining high-quality pediatric EEG recordings within 20 minutes of emergency department presentation.
- To evaluate the time to EEG application and recording quality in a pediatric emergency setting.
Main Methods:
- A single-center prospective feasibility study was conducted.
- Two-channel continuous EEG was recorded from pediatric patients (<16 years) with altered consciousness.
- Data collected included time to application, recording duration, and percentage of artifact.
Main Results:
- Twenty pediatric patients were included in the study.
- The mean time to EEG application was 41.3 minutes, with a mean recording length of 93.1 minutes.
- Sixty-five percent of EEGs had less than 25% artifact, with higher artifact levels during airway management.
Conclusions:
- EEG monitoring is achievable in pediatric emergency departments within one hour.
- Artifact levels are generally low, except during airway manipulation.
- Further research is needed to explore EEG's role in early seizure detection and clinical decision-making.
Background:
Status epilepticus is the most common neurological emergency presenting to pediatric emergency departments. Nonconvulsive status epilepticus can be extremely challenging to diagnose, however, requiring electroencephalographic (EEG) confirmation for definitive diagnosis. We aimed to determine the feasibility of achieving a good-quality pediatric EEG recording within 20 minutes of presentation to the emergency department.
Methods:
Single-center prospective feasibility study in Cork University Hospital, Ireland, between July 2021 and June 2022. Two-channel continuous EEG was recorded from children (1) aged <16 years and (2) with Glasgow Coma Scale <11 or a reduction in baseline Glasgow Coma Scale in the case of a child with a neurodisability.
Results:
Twenty patients were included. The median age at presentation was 65.8 months (interquartile range, 23.2 to 119.0); 50% had a background diagnosis of epilepsy. The most common reason for EEG monitoring was status epilepticus (85%) followed by suspected nonconvulsive status (10%) and reduced consciousness of unknown etiology (5%). The mean length of recording was 93.1 minutes (S.D. 47.4). The mean time to application was 41.3 minutes (S.D. 11.7). The mean percent of artifact in all recordings was 19.3% (S.D. 15.9). Thirteen (65%) EEGs had <25% artifact. Artifact was higher in cases in which active airway management was ongoing.
Conclusions:
EEG monitoring can be achieved in a pediatric emergency department setting within one hour of presentation. Overall, artifact percentage was low outside of periods of airway manipulation. Future studies are required to determine its use in early seizure detection and its support role in clinical decision-making in these patients.
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