Accuracy and Impact of Point-of-Care Electroencephalogram Technology in an Emergency Department or Hospital Setting:...

The recent development of rapid point-of-care electroencephalogram (POC-EEG) devices could allow for more timely diagnosis and treatment of seizures, but currently there is no meta-analysis evaluating this new technology.

To assess the diagnostic accuracy and clinical impact of POC-EEG devices when compared with conventional EEG for diagnosing seizures.

A comprehensive search strategy of five databases was performed. Studies were considered if performed in the emergency department or intensive care unit and evaluated patients with concern for seizure. We included diagnostic accuracy studies if they evaluated accuracy of POC-EEG compared with conventional EEG. Separately, we included randomized controlled trials (RCTs) comparing care with and without POC-EEG to evaluate clinical impact. Data were extracted via PRIMSA guidelines through independent extraction by multiple reviewers. Risk of bias of diagnostic accuracy studies was assessed using the QUADAS-2 tool, and RCTs were assessed using the Cochrane Risk-of-Bias 2 tool. Primary outcome was the sensitivity and specificity of POC-EEG compared with conventional EEG.

Thirteen studies met the inclusion criteria for diagnostic accuracy and one RCT met inclusion criteria for clinical impact. The diagnostic studies comprised 636 patients, and 149 were enrolled in the RCT. Most studies were high risk of bias. Pooled sensitivity of POC-EEG was 69% (95% confidence interval 55-80%) and specificity was 99% (95% confidence interval 95-100%).

POC-EEG technology has relatively poor sensitivity but high specificity in the detection of seizures compared with conventional EEG technology.