13 - Rapid Response EEG Decreases Time to Seizure Diagnosis in Pediatric ICU and ER Patients

Pediatric status epilepticus (SE) carries a high risk of morbidity and mortality and can result in neurologic injury. Establishing seizure activity on conventional EEG (cEEG) is essential but can delay treatment of subclinical seizures. cEEG requires technician expertise and equipment whose limited availability can further delay treatment. Rapid response EEG (rrEEG) device Ceribell and its Brain Stethoscope function can be used and interpreted rapidly by bedside providers with minimal training. This retrospective pilot study examines the impact of rrEEG introduction at a quaternary care children’s hospital on time to definitive diagnosis and treatment.

Objective:

The objective of this study was to compare the time to determination of electrographic activity (TDEA) between cEEG and rrEEG. Secondary outcomes were EEG setup time, accuracy of the Brain Stethoscope, and changes in clinical decision-making.

Design/Methods:

            This was a single center retrospective observational cohort study that analyzed data from patients 2-18 years old who presented to the PICU and pediatric ER with concern for SE. All EEG waveform data in both cohorts was interpreted by a board-certified epileptologist. For rrEEG patients, the bedside physician used the Brain Stethoscope at four discrete points. TDEA and setup time were recorded and compared using Welch’s T-test. Diagnostic specificity and sensitivity for SE using the Brain Stethoscope were calculated with the epileptologist assessment as the standard.

Results:

Data was collected from 8 pediatric patients on rrEEG and 12 patients on cEEG. When compared to cEEG, rrEEG decreased TDEA (128 ± 59min vs 24 ± 9min, P = .00003) and had a shorter setup time (22 ± 4min vs 11 ± 7min, P = 0.001). Bedside physicians diagnosed electrographic activity using the Brain Stethoscope with 100% sensitivity (95% CI 54% to 100%) and 84% specificity (95% CI 65% to 95%). rrEEG ruled out SE in 7 patients and changed physician clinical decision-making in 3 patients.

Conclusion(s):

            rrEEG allowed for earlier diagnosis of brain electrographic activity in pediatric patients when compared to cEEG. Despite 24/7 technician and epileptologist coverage, there was significant delay to diagnosis when using the cEEG. rrEEG allowed for the bedside provider to initiate EEG monitoring, successfully diagnose patients using the Brain Stethoscope, and decrease delays associated with technician availability. This promising rrEEG technology can facilitate faster assessment of SE in pediatric patients in ICU and ER settings and enhance patient safety and quality of care by potentially reducing ongoing neurologic injury.