Point‐of‐care electroencephalography enables rapid evaluation and management of non‐convulsive seizures and status epilepticus in the emergency department

OBJECTIVES: To describe our institutional experience with point‐of‐care electroencephalography (pocEEG) and its impact on the evaluation/management of suspected non‐convulsive seizures in the emergency department (ED). METHODS: We retrospectively identified 157 adults who underwent pocEEG monitoring in our community hospital ED in 1 year. We calculated the time to obtain pocEEG in the ED (door‐to‐EEG time) and examined the impact of pocEEG findings (categorized as seizure, highly epileptiform patterns, slowing, or normal activity) on antiseizure medication treatment. RESULTS: PocEEG revealed seizures (14%, n = 22), highly epileptiform patterns (22%, n = 34), slowing (44%, n = 69), and normal activity (20%, n = 32). The median door‐to‐EEG time (from initial ED evaluation to pocEEG monitoring) was only 1.2 hours (interquartile range 0.1–2.1) even though 55% of studies were performed after‐hours (5 pm–9 am). Most patients were admitted (54% to the intensive care unit, 41% to floor). Antiseizure medication treatment occurred pre‐pocEEG in 93 patients (59%) and post‐pocEEG in 88 patients (56%). By reviewing the relationship between pocEEG monitoring and antiseizure medication management, we found a significant association between pocEEG findings and changes in management (P < 0.001). Treatment escalation occurred more frequently in patients with epileptiform activity (seizures or highly epileptiform patterns, 52%) than patients with non‐epileptiform activity (normal or slow, 25%, P < 0.001), and avoidance of treatment escalation occurred more frequently in patients with normal or slow activity (27%) than patients with seizures or highly epileptiform patterns (2%, P < 0.001). CONCLUSION: Our study, the largest to date describing the real‐world use of pocEEG in emergency medicine, found that rapid EEG acquisition in the ED was feasible in a community hospital and significantly affected the management of suspected non‐convulsive seizures.