Continuous EEG Monitoring in Canadian Hospitals: A Nationwide Cross-Sectional Survey

Area of Science:

• Neurology
• Critical Care Medicine
• Medical Technology

Background:

• Continuous electroencephalography (cEEG) is the gold standard for diagnosing nonconvulsive seizures (NCSs) and nonconvulsive status epilepticus (NCSE) in critically ill patients.
• NCSE affects 8%-10% of patients with unexplained coma, and untreated NCSs increase mortality and morbidity.
• cEEG monitoring identifies more seizures than routine EEG, but its use in Canada is understudied.

Purpose of the Study:

• To evaluate the availability, indications, and barriers to continuous EEG (cEEG) access in Canadian hospitals.
• To assess current cEEG monitoring practices across Canadian adult healthcare institutions.

Main Methods:

• A national cross-sectional survey was distributed to directors of EEG laboratories and physicians interpreting cEEGs in Canadian adult hospitals.
• The survey assessed institutional cEEG availability, clinical applications, and technical infrastructure.

Main Results:

• Only 19 Canadian hospital networks (2% of all hospitals) reported cEEG availability, with significant geographic disparities and lack of access in 3 provinces and 3 territories.
• Tertiary care centers had only 68% cEEG availability.
• Barriers included insufficient EEG technologist coverage, long processing times, lack of standardized guidelines, and limited after-hours access.

Conclusions:

• Continuous EEG (cEEG) availability in Canada is critically limited, even in tertiary care centers, with substantial geographic and operational challenges.
• Most Canadian hospitals do not meet international guideline standards for cEEG utilization.
• Systemic changes are needed to improve cEEG access and align Canadian practices with global standards.