Abstracts

Rationale: In our institution, patients admitted to the Emergency Department (ED) are able to have an EEG, without being seen by a neurologist. Most clinicians working in the ED are specialists in training in internal medicine or in emergency care. Although evidence-based data for the indications of realization of an EEG in emergency do not exist, there are published guidelines, which are expert opinion ((Praline et al. Emergency EEG: actual indications and results; Neurophysiol Clin 2004 ; 34 :175-181). We decided to perform a survey about the knowledge of those guidelines by the ED physicians. This was part of a study done to improve the use of emergent EEG in our institution. Methods: We designed a small survey consisting of 10 short clinical cases and asked the clinicians if they would ask an emergent EEG or not. These cases were classical situations seen in the ED: i.e. patient with alcohol withdrawal seizures, possible first epileptic seizure, unexplained unconsciousness, minor head trauma, possible encephalitis, history of recurrent syncope… According to published guidelines, are considered as indications of emergent EEG: patients admitted for acute confusional state, for coma or for possible first epileptic seizure. Results: 28 physicians accepted to participate to the survey. 26 were in training and 2 were fully trained emergency care clinicians. 35% would not ask an EEG in case of altered mental status, and thus did not consider the diagnosis of non convulsive status epilepticus. 21% would not ask an emergent EEG for possible first epileptic seizure, and thus would loose the possibility of doing it in the first 24 hours. This would increase the chance of having epileptiform discharges and would help in epileptic syndrome classification. 21 % would prescribe an EEG for possible encephalitis, 14% for alcoholic withdrawal seizure, 10% for minor head trauma, 7% for a seizure occurring during a hypoglycaemia, 68% for syncope, and 46% for breakthrough seizure in a known epileptic patient. Conclusions: Guidelines about usefulness of prescription of an emergent EEG in the ED are not well known in our academic hospital. This is an illustration of the need of continuous medical education in non EEG specialists.