Abstracts

Rationale: Status epilepticus (SE) is a medical emergency associated with significant morbidity and mortality. Prompt identification of SE is essential in initiating appropriate treatment. There is usually little diagnostic dilemma associated with identifying convulsive SE. Non-convulsive status epilepticus (NCSE), however, can present a diagnostic challenge, and electroencephalogram (EEG) is an invaluable tool in diagnosing NCSE in comatose patients. The purpose of this study was to determine the yield of stat inpatient EEG in the diagnosis of SE at a tertiary referral center. Methods: We reviewed all consecutive inpatient EEGs from July 1, 2007 to April 30, 2008 at Tampa General Hospital (TGH) in Tampa, FL, a typical tertiary referral center. All the EEGs had been interpreted by an attending neurologist prior to review for the study. "Stat EEGs" were identified by reviewing the computerized requisition form. Results: During the 10-month study period, 1058 inpatient EEGs were performed. Sixty-one(5.8%) were ordered stat. Twenty-one (34%) EEGs were ordered by neurologists and neurosurgeons, and the remainder by other services. Six stat EEGs (9.8%) demonstrated status epilepticus, of these, 2 (3.3%) were NCSE and 4 (6.6%) were convulsive SE. Seventeen (27.9%) were normal, 7 (11.5%) showed epileptiform discharges but no EEG seizure pattern. The other 31 (50.8%) showed other encephalopathic patterns (triphasic pattern, various degrees of slowing, burst suppression, background suppression, electrocerebral inactivity). Conclusions: The only accepted indication for stat EEGs is NCSE. In this study, less than 4% of stat EEGs showed NCSE. Many EEGs were ordered stat without a good reason. Stat EEGs are useful clinically and should be available at large hospitals, but guidelines for the “stat” indication would be useful.