Reduced-lead electroencephalography performed at the discretion of emergency physicians in pediatric cases of altered mental status: A retrospective observational study.

Background

Altered mental status (AMS) is frequently encountered among children in emergency departments (ED) and represents a nonspecific manifestation of brain dysfunction. However, the extent to which reduced-lead electroencephalography (EEG) findings obtained and interpreted by ED physicians influence treatment decisions and predict clinical outcomes has not yet been adequately evaluated.

Methods

Epileptologists retrospectively analyzed the medical records and reduced-lead EEG findings of pediatric patients (aged <18 years) presenting to the ED with AMS and suspected electrographic seizures (ESz) between March 1, 2019, and February 28, 2023, yielding 51 EEG recordings with minimal artifacts for final analysis. Subsequently, we investigated whether ED physicians implemented appropriate clinical interventions guided by these EEG results.

Results

Anti-seizure medication (ASM) was administered during EEG monitoring in 20 of 27 patients with febrile seizures (FS) (74.1%), four of eight patients with acute encephalopathy/encephalitis (AE/AES) (50.0%), and 14 of 16 patients with epilepsy (87.5%). ESz were identified in eight patients with FS (29.6%), two patients with AE/AES (25.0%), and 15 patients with epilepsy (93.8%). ESz resolved during EEG monitoring in all patients except for one patient with FS. Five patients with AE/AES (62.5%) and one patient with epilepsy (6.3%) developed neurological sequelae, whereas no patients with FS developed neurological sequelae.

Conclusions

Reduced-lead EEG can be effectively performed by ED physicians and may be a useful tool to facilitate timely intervention for ESz. However, we were unable to determine whether the intervention for ESz in the hyperacute phase of the ED contributed to improved outcomes.