Assessment of the diagnostic utility of the electroencephalogram in pediatric emergencies
M J Abenza Abildúa1, T Olmedo Menchen2, A Pérez Villena3
1Sección de Neurología, Centro de Medicina del Sueño, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; Fundación para la Investigación e Innovación Biomédica del Hospital Universitario Infanta Sofía y Hospital Universitario del Henares, Madrid, Spain.
Insights
Urgent electroencephalogram (EEG) in children showed abnormalities in a third of cases, aiding epilepsy diagnosis and treatment initiation. Normal EEGs ruled out epilepsy in suspected cases and confirmed non-epileptic events.
Area of Science:
- Pediatric Neurology
- Diagnostic Imaging
- Clinical Neurophysiology
Background:
- Urgent electroencephalogram (EEG) utility in pediatric emergency care is crucial for timely diagnosis.
- Evaluating the diagnostic yield of urgent EEGs in children under 16 is essential for optimizing emergency department protocols.
Purpose of the Study:
- To analyze the diagnostic utility of urgent electroencephalogram (EEG) in children under 16 years of age.
- To assess the impact of urgent EEG findings on clinical decision-making and treatment initiation in pediatric patients.
Main Methods:
- A descriptive, retrospective, observational study of consecutive pediatric patients (0-16 years) undergoing urgent EEG from January to December 2022.
- Analysis included patient demographics, reasons for consultation, EEG results, and subsequent diagnoses and treatments.
Main Results:
- Of 70 pediatric patients, 37% had abnormal EEGs. Nearly half of patients with suspected epilepsy showed EEG abnormalities, confirming diagnoses and guiding treatment.
- No abnormalities were found in patients with suspected syncope or paroxysmal disorders. A quarter of those with atypical febrile seizures had abnormal EEGs.
Conclusions:
- Urgent EEGs in children are valuable, with approximately one-third revealing abnormalities that influence clinical management.
- The study highlights the EEG's role in confirming epilepsy, guiding treatment, and differentiating from other conditions like syncope or febrile seizures.
- Normal EEG findings effectively ruled out epilepsy in suspected cases and supported diagnoses of non-epileptic events.
Introduction:
We analyze the diagnostic utility of urgent EEG (electroencephalogram) performed in children under 16 years of age in our center.
Material And Methods:
Descriptive, retrospective, observational study of consecutive patients from 0 to 16 years of age, who underwent an urgent EEG for any reason, from January to December 2022.
Results:
Of the 388 patients, 70 were children: 37 (52.85%) women, and 33 (47.14%) men. Average age: 6.27 ± 4.809. Of the 70 patients, 6 (8.57%) had previous epilepsy. Reasons for consultation: 17 febrile seizures, 10 first focal seizures, 10 first TCG seizures, 6 paroxysmal episodes, 6 absences, 3 myoclonus of extremities, 3 syncope, 2 SE, 2 visual alterations, 2 low level of consciousness, 2 cyanosis, 2 suspected meningitis or encephalitis, 1 choking, 1 atypical headache, 1 chorea, 1 presyncope, 1 language delay. Of the 70 patients, 47 had a normal EEG (67.14%). Of the 47 patients with a normal EEG, 10 were diagnosed with epilepsy, and 3 of them began receiving antiepileptic treatment upon discharge. None of the patients with suspected syncope or paroxysmal disorder (17 patients, 24.28%) had EEG abnormalities. Of the 17 patients with atypical febrile seizures, 3 had EEG abnormalities.
Conclusions:
A third of the EEG records performed in the Emergency Department showed alterations, probably due to the time taken. Almost half of the patients with suspected epilepsy or EE showed EEG abnormalities, which confirmed the diagnosis in these cases and encouraged the clinician to start drug treatment. No case with a high suspicion of epilepsy was dismissed due to the normality of the EEG recording in our series. No patient diagnosed with syncope or paroxysmal disorder had EEG abnormalities. Nearly a quarter of patients with atypical febrile seizures showed EEG abnormalities. We barely register cases of status epilepticus, probably due to the degree of complexity of our center.
