Objective:

To evaluate the utility of stat EEG in detecting seizures and its role in acute neurological conditions.

Background:

Emergency situations often require rapid diagnostic approaches. Stat EEG is mainly indicated for cases of unexplained altered consciousness where nonconvulsive status epilepticus (NCSE) is suspected. However, frequent inappropriate ordering can overburden the neurodiagnostic team.

Design/Methods:

A retrospective study was conducted on all stat EEGs ordered from October 1, 2023, to January 31, 2024. Standard EEG montages with 20 electrodes were used, recording for 21-24 minutes, including ECG and responses to stimuli. Data on ordering reasons, requesting specialties, Glasgow Coma Scale scores, neuroimaging findings, and diagnostic impact were analyzed.

Results:

During the review period, 186 inpatient stat EEGs were performed on patients ranging from 18 to 92 years old (59% male, 41% female). Abnormal results were found in 85% (n=159) of all stat EEGs: 65% (n=120) showed diffuse slowing, 11% (n=20) showed focal slowing, 8% (n=15) showed epileptiform discharges, and 2% (n=4) indicated status epilepticus or seizures. Neuroimaging revealed that 58% (n=108) of patients had structural brain abnormalities, with 85% (n=17) of those with focal slowing also showing corresponding abnormalities. The most common reason for stat EEG orders was altered mental status (45%, n=83). Stat EEGs ordered by Critical Care Medicine (39%, n=73) and Internal Medicine (32%, n=60) were the most frequent, followed by Neurology (11%, n=20) and other specialties. The detection rate for ictal or interictal discharges was 25% (n=3) for ED, 20% (n=4) for Neurology, 10% (n=7) for Critical Care, 7% (n=4) for Internal Medicine, and 6% (n=1) for Surgical Critical Care.

Conclusions:

The study suggests that stat EEGs have a limited yield in detecting active seizures, particularly for non-convulsive conditions. Implementing clear criteria and structured triage processes can enhance the utility of stat EEGs, optimizing resource use and improving diagnostic accuracy.