Implementation of point-of-care EEG in a pediatric emergency department: a quality improvement study

Central nervous system disorders are among the most common reasons for pediatric emergency department (PED) visits. Status epilepticus (SE) and nonconvulsive status epilepticus (NCSE) are particularly concerning, and the latter requires electroencephalography (EEG) for diagnosis. However, standard EEG is resource intensive and rarely available outside regular working hours. Point-of-care EEG (pocEEG) is a novel tool for rapid neuromonitoring in the PED. We aimed to implement pocEEG as a quality improvement initiative in a tertiary pediatric hospital. A simplified two-channel EEG setup was gradually implemented in the PED. A convenience sample of patients was recruited to assess feasibility. The clinical data of 62 pocEEG recordings were retrospectively analyzed. Concordance was assessed with standard EEGs within 48 h. Abnormal findings were observed in 45% (28/62) of pocEEGs, more frequently in patients with known pre-existing conditions (18/28 vs. 10/28, p = .024). Seizure activity was recorded in 16% of cases (10/62), mostly in patients with pre-existing conditions (8/10). Concordance between pocEEG and standard EEG was assessed in 37/62 pocEEGs, of which 68% were concordant and 8% normalized before standard EEG. pocEEG influenced 60% of clinical decisions by aiding altered mental status (AMS) assessment, antiseizure medication guidance in active SE, and NCSE identification.

pocEEG is a feasible and effective tool for rapid neuromonitoring in the PED. It aids seizure detection, AMS evaluation, and treatment decisions. Further research is warranted to assess its impact on time to diagnosis, seizure duration, outcomes, cost-effectiveness, and standardized workflows for timely standard EEG follow-up.

• Altered mental status (AMS) and seizures are frequent and high-acuity presentations in pediatric emergency critical care settings. • Nonconvulsive status epilepticus can only be diagnosed by EEG, yet immediate access to standard EEG is often unavailable.

• This quality improvement study shows that simplified, point-of-care EEG (pocEEG) can be successfully implemented and is a valuable tool for rapid neuromonitoring. • The study demonstrates feasibility of pocEEG with enhanced seizure detection and AMS assessment with the potential to bridge critical diagnostic gaps where 24/7 standard EEG is unavailable.