Abstracts

Rationale: For patients admitted to the Emergency Department (ED), EEG is an exam easily available, at least during working hours. 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 conducted a pilot study to investigate the use of EEG in the Emergency Department of the Hôpital Erasme, Brussels, Belgium. This was part of a study done to improve the use of emergent EEG in our institution. Methods: Between September 2008 and January 2009, all emergent EEGs from adult patients admitted to the ED were prospectively collected. An EEG was considered to be done in emergency if it was performed within 24 hours of admission. All indications and results were noted. Impact of the EEG protocol on patient’s diagnosis and influence on treatment were assessed by direct interview of the clinician on charge or by reviewing the chart. 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. During the same period of time, the charts of all patients admitted to the ED were reviewed to find the number of patients admitted for these reasons and who did not get an EEG. Results: 99 emergent EEGs were done on patients from the ED. 79% of them were done for reasons in accordance with the guidelines. For the remaining 21%, indications were diverse (i.e. head trauma, seizures in known epileptic patients). The EEG result was considered as useful in 81% of the cases, mostly because it allowed ruling out non convulsive status epilepticus. It led to direct change in the treatment in 24 % of them. A total of 13596 patients were examined during the same period of time in the ED. We were able to find 127 patients admitted for confusion, coma or possible first epileptic seizure who did not get an emergent EEG. Conclusions: In our institution, EEG is underused in the ED but when an EEG is performed, it is for reasons in accordance with guidelines in almost 80% of the cases.