Abstracts

Rationale: Epilepsy remains a clinical diagnosis despite known predilection of associated abnormal electrical activity. Seizure or seizure like event related admissions as well as paroxysm movement related hospital stays are common. EEG is a standard tool used to assess diagnosis of epilepsy / epilepsy syndrome and sometimes to guide treatment ie in non-convulsive seizures. Practice remains to perform an EEG to ascertain risk of epilepsy. EEG remains a test primarily ordered by neurologists even though at times we notice other providers ordering EEG on clinical suspicion. However, despite guidelines clinicians remained uncertain about when and for whom to request an EEG. Misconceptions about the diagnostic capability of EEG are common and consequently, its use is suboptimal. In this study we aim to understand the use of EEG as a diagnostic tool for medical decision making across various inpatient services in a tertiary care center. Also we try to understand the role of neurologic consultation and recommendations to improve utility of EEG for medical decision making in diagnosis and management of epilepsy. Methods: Institutional IRB approval was obtained for performing this retrospective study. We reviewed data from all patients between ages 1 yr – 89 yrs receiving inpatient routine EEG testing from January 2016 to February 2016 in our institution. All EEG records except long term Video EEG were considered. Data set points included age, gender, race, admission and discharge diagnosis, service requesting EEG, indication for EEG, whether neurologic consultation was obtained ; if yes – then prior / after to ordering EEG, EEG findings, role of imaging, changes in antiepileptic medications and discharge diagnosis. Statistical analysis was completed using IBM SPSS software. Results: Total of 190 charts were included in the review in our study. As expected, most studies were ordered via the primary neurological services ie 47.84 % such as general neurology teams, vascular neurology and neuro ICU teams. 52.16 % of inpatient EEGs were ordered on non-neurological services. 1/27 ie 3.7% patients on vascular neurology service, 9/17 ie 52.94% patients on general neurology service, 13/47 ie 27.5 % patients on neuro ICU service who underwent inpatient EEG were given diagnosis of epilepsy or changes made in AED regimen during inpatient stay.As against, 6/37 ie 16.21 % patients on general medicine services, 5/23 ie 21.73 % patients on all other ICUs, 0/7 patients on neurosurgical service and 13/30 ie 43 % patients on pediatric service who underwent inpatient EEG were given diagnosis of epilepsy or changes made in AED regimen during inpatient stay.Neurologic involvement in terms of primary neurology service or consultation service was noticed in 90.51% patients. Retrospective neurology consultation was requested after obtaining an EEG in 2.63% patients. Also, on 6.82% patients neurology was never consulted nor were they given diagnosis of epilepsy or were managed with AEDs. Conclusions: Misconceptions exist about utility and yield of inpatient EEG studies. Surprisingly our study revealed frequent ordering of EEGs by vascular neurology service with extremely low yield in terms of alteration of medical management. One patient out of 27 who underwent EEG testing was started on AED; more so, chart review revealed EEG study did not impact clinical decision making in his case. Most providers in the inpatient settings prefer neurologic consultation prior to ordering EEG study. Overall, EEG studies altered management in 35% patients. While timely ordering of EEG testing is of great diagnostic and therapeutic value for the correct cohort, it can also be over utilized as a testing tool. Funding: None