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Impacto del microEEG en el Manejo Clínico y en los Resultados de los Pacientes con Alteración del Nivel de Consciencia en el Servicio de Urgencias: Un Ensayo Clínico Controlado Aleatorizado
Author(s) -
Zehtabchi Shahriar,
Abdel Baki Samah G.,
Omurtag Ahmet,
Sinert Richard,
Chari Geetha,
Roodsari Gholamreza S.,
Weedon Jeremy,
Fenton André A.,
Grant Arthur C.
Publication year - 2014
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12324
Subject(s) - medicine , emergency department , randomized controlled trial , altered mental status , confidence interval , intensive care unit , electroencephalography , emergency medicine , pediatrics , intensive care medicine , psychiatry
Abstract Objectives Altered mental status ( AMS ) is a common presentation in the emergency department ( ED ). A previous study revealed 78% electroencephalogram ( EEG ) abnormalities, including nonconvulsive seizure ( NCS ; 5%), in ED patients with AMS . The objective of this study was to assess the impact of EEG on clinical management and outcomes of ED patients with AMS . Methods This was a randomized controlled trial at two urban teaching hospitals. Adult patients (≥18 years old) with AMS were included. Excluded patients had immediately correctable AMS (e.g., hypoglycemia) or were admitted before enrollment. Patients were randomized to routine care (control) or routine care plus EEG (intervention). Research assistants used a scalp electrode set with a miniature, wireless EEG device (micro EEG ) to record standard 30‐minute EEG s at presentation, and results were reported to the ED attending physician by an off‐site epileptologist within 30 minutes. Primary outcomes included changes in ED management (differential diagnosis, diagnostic work‐up, and treatment plan from enrollment to disposition) as determined by surveying the treating physicians. Secondary outcomes were length of ED and hospital stay, intensive care unit ( ICU ) requirement, and in‐hospital mortality. Results A total of 149 patients were enrolled (76 control and 73 intervention). Patients in the two groups were comparable at baseline. EEG in the intervention group revealed abnormal findings in 93% (95% confidence interval [ CI ] = 85% to 97%), including NCS in 5% (95% CI = 2% to 13%). Using micro EEG was associated with change in diagnostic work‐up in 49% (95% CI = 38% to 60%) of cases and therapeutic plan in 42% (95% CI = 31% to 53%) of cases immediately after the release of EEG results. Changes in probabilities of differential diagnoses and the secondary outcomes were not statistically significant between the groups. Conclusions An EEG can be obtained in the ED with minimal resources and can affect clinical management of AMS patients.