Utility of electroencephalography: Experience from a U.S. tertiary care medical center

•An average delay of 4 h exists between the request for EEG monitoring and its initiation.•Seizures were detected in less than 6% of EEGs, and 45% of emergency department EEGs were normal.•The observed delay and low diagnostic yield represent significant inefficiencies in EEG practice.

ObjectiveTo investigate the utility of electroencephalography (EEG) for evaluation of patients with altered mental status (AMS).MethodsWe retrospectively reviewed 200 continuous EEGs (cEEGs) obtained in ICU and non-ICU wards and 100 spot EEGs (sEEGs) obtained from the emergency department (ED) of a large tertiary medical center. Main outcomes were access time (from study request to hookup), and diagnostic yield (percentage of studies revealing significant abnormality).ResultsAccess time, mean ± SD (maximum), was 3.5 ± 3.2 (20.8) hours in ICU, 4.8 ± 5.0 (25.6) hours in non-ICU, and 2.7 ± 3.6 (23.9) hours in ED. Access time was not significantly different for stat requests or EEGs with seizure activity. While the primary indication for EEG monitoring was to evaluate for seizures as the cause of AMS, only 8% of cEEGs and 1% of sEEGs revealed seizures. Epileptiform discharges were detected in 45% of ICU, 24% of non-ICU, and 9% of ED cases, while 2% of ICU, 15% of non-ICU, and 45% of ED cases were normal.ConclusionsAccess to EEG is hampered by significant delays, and in emergency settings, the conventional EEG system detects seizures only in a minority of cases.SignificanceOur findings underscore the inefficiencies of current EEG infrastructure for accessing diagnostically important information, as well as the need for more prospective data describing the relationship between EEG access time and EEG findings, clinical outcomes, and cost considerations.