Pediatric patients commonly present to the pediatric emergency department (PED) with new-onset seizure-like activity. By the time pediatric neurology is consulted, patients have usually returned to clinical baseline. This can create division between emergency medicine physician, pediatric neurologist, and patient’s families about the next appropriate diagnostic steps and follow-up clinical management in the inpatient or outpatient setting. Delayed follow-up can lead to poor outcomes, including recurrent ER visits, unnecessary hospital admissions, parental dissatisfaction, and delayed diagnosis. Depending on the patient’s epilepsy risk factors, and provider and parental level of concern, an electroencephalogram (EEG) performed in the PED may be beneficial in providing quicker disposition and improved utilization of resources. Our study evaluated EEG studies performed in the ED over a 6-month period and assessed patient disposition outcome.

Over a 6-month period from January-July 2025, routine (41-60 minute) EEGs (n=71) utilizing the 10-20 system were performed in the ED at the Nicklaus Children’s Hospital.  71.8% studies were performed between 9 am-5 pm and 28.2% studies were performed between 5 pm-9 am. The most common chief complaint for EEG studies were abnormal movements (52.1%) followed by seizure (25.4%), syncope (18.3%), and febrile seizure (4.2%).

After EEGs were performed, 59.5% were discharged without need for further inpatient/outpatient workup, 16.9% were evaluated within one-week in an outpatient neurology clinic, and about 24% were admitted for inpatient workup.

Our study shows how routine EEG can be a useful diagnostic modality in the PED. It can be helpful in discharging or expediting inpatient/outpatient care for patients as well as improve patient’s family satisfaction. Careful consideration must be assessed on numerous factors that may make this a challenge such as hospital resources and appropriate EEG technician staffing.