Abstracts

Rationale: Introduction: Many hospitals do not have the capability to perform electroencephalography (EEG) quickly on every patient suspected of having nonconvulsive status epilepticus (NCSE). Often, clinicians have to treat based on clinical suspicion. Currently, there is controversy about how urgently NCSE needs be diagnosed and treated. We sought to determine if differences in time to getting an EEG from when NCSE was first suspected affected outcomes in non-cardiac arrest patients.  Methods: Methods: New York Presbyterian-Queens (NYPQ) is a community hospital with limited EEG machines and no around-the-clock technicians to perform EEG in after hours. All patients reported to have status epilepticus (SE) on EEG (routine and continuous) done at NYPQ from January 2012 - September 2017 were included in the study. All studies were reviewed by a board certified epileptologist (DTC) to confirm NCSE. NCSE was defined as EEG evidence of seizure burden greater than 30 minutes in a one-hour interval, or a series of electrographic seizures without complete clinical recovery. Those without NCSE, with convulsive SE, or post-cardiac arrest were excluded. The elapsed time between when EEG was ordered by physician and EEG was started and mortality outcome data were collected. Binary logistic regression method was used to analyze the data with Microsoft Excel.  Results: Results: During our study period, 74 adult patients were reported to have SE based on EEG reports. Of these 74 patients, SE was confirmed in 44 patients. Patients were excluded if after review of their EEGs, were found not to be in SE due to disagreement with the original interpretation or not enough seizure burden to meet SE threshold. Out of those in SE, 11 were excluded due to post- cardiac arrest, 2 excluded for convulsive SE, and 1 excluded for having both. Of the remaining 30 patients, 8 died in the hospital, 2 discharged to hospice, 2 discharged home and 18 discharged to nursing facility. Of the patients who died in hospital or were discharged to hospice, the delay to start EEG was mean of 14.2 with a standard error (SE) of 2.9 hours. For patients who were discharged to home/nursing facility, the delay was mean of 18.4 with SE of 2.8 hours. There was no significant difference between the two groups (p=0.35).  Conclusions: Discussion: We found that delay in obtaining EEG recording when NCSE is suspected does not worsen mortality outcome. This study suggests hospitals with limited resources may improve outcome by investing resources in other areas aside from EEG and raises questions on how urgently NCSE need be diagnosed and treated. This study has all the limitations of a retrospective study with a small sample size. We also did not examine if patients were started on anti-seizure medications prior to obtaining the EEG and how long patients were in NCSE. In addition, we did not examine cause of death since patient’s death may not be related to NCSE. We hope to address these issues in the future and to continue to add patients to our data set. Funding: Funding to support the salary of research assistant provided by private non-commercial donors.