6 Reasons Emergency Departments Should Consider Point-of-Care EEG

Emergency physicians are often quoted as saying that emergency medicine requires the endurance of a marathoner, and the speed of a sprinter. In this fast-paced environment, undetected brain issues can pose significant, even life-threatening risks for patients. This makes acute neurology care one of the biggest challenges for emergency department (ED) care teams.

Seizures can be quite common among critically ill patients.  One study found that nearly a third of people hospitalized with acute conditions experienced seizures.ⁱ Many of these abnormal episodes are asymptomatic or may present in ways other than convulsion, so they can only be spotted through EEG monitoring. Since most EDs don’t use conventional EEG within their own department, non-convulsive seizures (NCS) and non-convulsive status epilepticus (NCSE) can go undetected or misdiagnosed in many ED patients. Research supports that spotting NCS and NCSE is challenging for emergency clinicians.  In a study conducted entirely within one ED,  seizure activity through electroencephalographic monitoring was found in nearly 40% of patients with critical symptomsⁱⁱ.

Unfortunately, conventional EEG isn’t built for the ED. The equipment can be bulky and isn’t quite as portable. Skilled specialists required for set up and monitoring may not be readily available. There may not be a neurology department in the same location. Neurology consults may not be available during off-hours. An extended timeline to diagnosis and treatment for patients with NCS and NCSE can lead to a host of problems for the ED, from disruption of workflow to poorer patient experiences, and even worsening overall health outcomes.

The Promise of Point-of-Care EEG  

Rapid identification of patients with potential NCS and NCSE is critical to improving both individual and overall health outcomes within the ED, along with other performance metrics important at the frontline of care. Fortunately, point-of-care EEG (POC-EEG) technology is available to help address these challenges. Designed for rapid deployment within acute care environments, POC-EEG devices offer enormous benefit to ED care teams and neurologists including:   

• Rapid EEG monitoring to identify potential NCS and NCSE patients on a timelier basis.
• Easy setup without the need for specially trained EEG technicians.
• Minimal disruption to ED workflows, resulting in better performance metrics.
• Prevention of overtreatment in patients without seizures.
• Stronger collaboration between neurology and ED departments.
• Reduction in unnecessary transfers to specialty neurology centers.

While the capabilities of these devices are not as robust as conventional EEG, POC- EEG provides reliable, real-time data that offers an efficient bridge between emergency medicine and neurology care. In addition, the latest POC-EEG devices represent major technological advancements, making rapid EEG an even more valuable tool for busy ED care teams.

Here are the primary reasons why emergency medicine clinicians and administrators should seriously consider adding POC-EEG to their departments:

1. Emergency physicians have recognized the need for rapid EEG for years.
   One study noted that EEG was useful for more than three quarters of patients.iv In a small test where an ED adopted routine EEG screening, AEDs changed in 8.4% and clinical management changed in 76.7% of people.  In an observational study published in Emergency Medicine Journal, POC-EEG was rated as useful and/or diagnostic in 92% of pediatric patient cases. The challenges of acute neuro care in the ED have been known for some time. Research consistently demonstrates the positive impact of routine EEG in the ED on both clinical management and antiepileptic drug (AED) therapy for critically ill and injured patients.  In 2011, ED physicians presented a compelling, data-backed argumentⁱⁱⁱ of the positive impact of EEG technology specifically designed for acute care environments. 
2. Routine, conventional EEG is not an option in the ED.
   Most EDs don’t have rapid access to EEG, or the trained EEG technicians required to setup and begin monitoring brain activity. In addition, many smaller, rural or remote providers may experience a shortage of neurologists or epileptologists available onsite or during off-hours. In 2016, the American Journal of Emergency Medicine published a study noting only 3% of ED patients with suspected seizures or status epilepticus had EEG confirmation of seizures within 24 hours^vi. This demonstrates the impact of poor resource availability, which continues to increase throughout the U.S^vii and globally. 
3. More accurate preliminary data leads to more informed referrals.
   Emergency physicians are the experts at rapid diagnosis of life-threatening conditions, yet NCS and NCSE are nearly impossible to detect without EEG. While patients with brain injuries, strokes or other brain-related illnesses may be clear choices for conventional EEG analysis, people entering the ED with altered mental states (AMS), potential drug interactions or intoxication, and other common illnesses may not be obvious candidates. POC-EEG offers the ability to rapidly screen patients for potential brain issues, and more confidently recommend neurology consultations.
4. Rapid EEG deployment improves key ED performance metrics.
   Emergency care teams and departments are measured on a combination of efficiency and health outcomes. Each decision made in the ED must balance maintaining quality of care with speed and resource allocation. Waiting for EEG may tie up critical resources when time is of the essence.The benefits of POC-EEG point to an opportunity to improve key ED metrics including reducing time to treatment, shortened length of stay (LOS), optimized bed flow, and greater resource utilization^viii. As more POC-EEG devices are introduced with features such as secure access to data remotely, algorithms based on larger, trusted datasets, and integration with clinician workflows, EDs utilizing POC-EEG will see even more improvement to their performance metrics.
5. POC-EEG reduces costs for patients and providers. Rapid EEG demonstrates impressive potential for reducing overall costs due to misdiagnosis, longer LOS, unnecessary transfers, and unnecessary use of AED and other medications. Perhaps the greatest cost savings may be in the reduction of staffing costs due to a decreased reliance on after-hours EEG technologists for initial setup and monitoring when NCS and NCSE is suspected.
6. The newest POC EEG technology is cost-effective and even more powerful. The first models of POC-EEG devices faced skepticism due to concerns about noise artifacts, lack of workflow integration, and patient discomfort. Those barriers are disappearing as newer POC-EEG devices appear on the market with substantial improvements to earlier technologies including:  

• • Trusted algorithms that reduce false positives and enhance seizure detection accuracy. 
  • Seamless integration with existing neurology software and hospital systems. 
  • More comfortable, lightweight designs for patient-friendly EEG monitoring. 
  • Enablement of remote neurology consultations for improved accessibility to acute neuro case.  
  • Newer POC-EEG devices are portable, wireless and affordable, delivering a fast, strong return on investment.  

The Time for POC-EEG in the ED is Now 

The demands of emergency medicine require fast, effective acute neuro care technology that helps, rather than hinders existing ED workflows. POC-EEG significantly shortens the time to accurately diagnose and treat patients with subtle or no seizure symptoms. With the right POC-EEG device, faster identification of potential NCS and NCSE patients leads to improved patient outcomes, reduced costs, and better ED performance metrics.

Sources:

i. Westover MB, Shafi MM, Bianchi MT, Moura LM, O’Rourke D, Rosenthal ES, Chu CJ, Donovan S, Hoch DB, Kilbride RD, Cole AJ, Cash SS. The probability of seizures during EEG monitoring in critically ill adults. Clin Neurophysiol. 2015 Mar;126(3):463-71. doi: 10.1016/j.clinph.2014.05.037. Epub 2014 Jul 11. PMID: 25082090; PMCID: PMC4289643.
ii. Privitera MD, Strawsburg RH. Electroencephalographic monitoring in the emergency department. Emerg Med Clin North Am. 1994 Nov;12(4):1089-100. PMID: 7956889.
iii. Abdel Baki, S.G., Omurtag, A., Fenton, A.A. et al. The new wave: time to bring EEG to the emergency department. Int J Emerg Med 4, 36 (2011). https://doi.org/10.1186/1865-1380-4-36
iv. Rodríguez Quintana JH, Bueno SJ, Zuleta-Motta JL, Ramos MF, Vélez-van-Meerbeke A; , the Neuroscience Research Group (NeuRos). Utility of Routine EEG in Emergency Department and Inpatient Service. Neurol Clin Pract. 2021 Oct;11(5):e677-e681. doi: 10.1212/CPJ.0000000000000961. PMID: 34840882; PMCID: PMC8610534.
v. Simma L, Bauder F, Schmitt-Mechelke T Feasibility and usefulness of rapid 2-channel-EEG-monitoring (point-of-care EEG) for acute CNS disorders in the paediatric emergency department: an observational study. Emergency Medicine Journal 2021;38:919-922.
vi. Kadambi P, Hart KW, Adeoye OM, Lindsell CJ, Knight WA 4th. Electroencephalography findings in patients presenting to the ED for evaluation of seizures. Am J Emerg Med. 2015 Jan;33(1):100-3. doi: 10.1016/j.ajem.2014.10.041. Epub 2014 Oct 30. PMID: 25468214; PMCID: PMC4847441.
vii. ASET Position Statement on the 24/7 Staffing for Neurodiagnostic Long-Term EEG Monitoring Services. (2022). The Neurodiagnostic Journal, 62(4), 251–259. https://doi.org/10.1080/21646821.2022.2145831
viii. Wright NMK, Madill ES, Isenberg D, Gururangan K, McClellen H, Snell S, Jacobson MP, Gentile NT, Govindarajan P. Evaluating the utility of Rapid Response EEG in emergency care. Emerg Med J. 2021 Dec;38(12):923-926. doi: 10.1136/emermed-2020-210903. Epub 2021 May 26. PMID: 34039642.

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