Authors :
Co-Author: Mohammad Sawahreh, MD – Sidra Medicine
Presenting Author: Abdel Rahman Salem, MD – Sidra Medicine
Khoulod Mohamed, MD – Pediatric Resident, Pediatrics, Sidra Medicine; AbdelRahman Salim, MD – Pediatric resident, Pediatrics, Sidra Medicine; Amani Hamid, MD – ED Fellow, Emergency Department, Sidra Medicine; Colin Powell, MB ChB, DCH, MRCP(UK), FRACP, FRCPCH, MD – Attending Physician, Sidra Medicine; Ruba Benini, Md PhD – Attending Physician, Child Neurology, Sidra Medicine
Rationale: Electroencephalography (EEG) is a cheap, non-invasive tool that plays an important role in the evaluation of children presenting with seizures and paroxysmal disorder. Although the role of video EEG is known in children evaluated in the acute and outpatient settings, literature on its utility in the pediatric emergency department (PED) remains limited. The objective of this study was to evaluate the yield and utility of video EEG in affecting the diagnosis, management and/or outcome of these patients.
Methods: A retrospective chart review analysis was conducted for all children who presented to the ED at tertiary pediatric center between January 2019 and December 2021 inclusive and underwent a video EEG in the ED. The primary objective was to determine the utility of video EEG in the evaluation of children presenting to the PED with seizures, other paroxysmal events and altered mental status. Secondary objectives included evaluating the following: 1. yield of video EEG in identifying abnormalities; 2. role of video EEG in decision making and in the management of the patient; and 3. role of video EEG in affecting the clinical outcomes. Various clinical variables were reviewed the following: demographic data, indication for video EEG, EEG result, EEG parameters, and clinical risk factors and outcomes.
Results: A total of 277 patients presenting to the PED during the three year study period underwent video EEG and were included. A total of 142 were females. Mean age at presentation was 7.7 yrs (± 5.4 years). Most common indications for EEG was new onset paroxysmal events (40%) followed by first unprovoked seizure (31%). Status epilepticus accounted for only 2% of cases. EEG duration ranged from thirty minutes to three hours (mean 77 min ±36 min). Majority of patients (61%) had their EEG done within 6 hrs of presentation to the ED. From time of symptom onset, 74% had their EEG within twelve hours. Abnormalities on EEG were noted in 61% with presence of epileptic discharges in 53%. In patients presenting with unprovoked seizures, EEG was abnormal in 64%. The clinical events of concern were captured on video EEG in 33 patients of which 25 had electroclinical seizures. Subclinical seizures were captured in ~2%. Decision to start anti-seizure medications based on EEG findings occurred in 50% of patients. In known epileptics, EEG in the ED impacted the decision to change the anti-seizure medications in 36 patients (13%). In 25% of cases, the results of the EEG resulted in the decision to request a neuroimaging study, in which a majority 75% were abnormal. In 75% of patients, the outcome of the ED visit was a home discharge.
Conclusions: To our knowledge, this is the first study evaluating the role of video EEG in the PED in a large pediatric cohort. This study reveals that video EEG in the PED is a high yield diagnostic tool in patients with new onset paroxysmal events. This yield impacted treatment decisions, including initiation of anti-seizure medications in the ED and decision to order neuroimaging studies. This study suggests that the routine use of video EEG in the ED enables early diagnosis and treatment of patients and may improve outcomes. The cost effectiveness and availability of this tool in all PED remains to be clarified.
Funding: N/A