Rapid response electroencephalography decreases time to seizure diagnosis in pediatric acute care patients

Abstract

Objectives

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 seizures due to technician limitations. 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, as well as the accuracy of the Brain Stethoscope.

Methods

This was a single center retrospective observational cohort study that analyzed data from patients 2–18 years old who presented with concerns for SE. For rrEEG patients, the bedside physician used the Brain Stethoscope at four discrete points. TDEA (time to diagnosis of electrographic activity) and setup time were recorded and compared using Welch's T-test. Diagnostic specificity and sensitivity for SE using the Brain Stethoscope were calculated against the epileptologist's assessment.

Results

Data were collected from 30 pediatric patients, 15 on each EEG modality. RrEEG decreased the average TDEA (132 min vs. 22 min, p < 0.001) and setup time (22 min vs. 9 min, p < 0.001), compared to the cEEG. Bedside physicians diagnosed electrographic activity using the Brain Stethoscope with 100% sensitivity (95% CI 63%–100%) and 92% specificity (95% CI 81%–97%). RrEEG ruled out seizures in 11 patients and changed clinical decision-making in five patients.

Significance

RrEEG allowed for earlier diagnosis of brain electrographic activity in pediatric patients when compared to cEEG. The bedside provider was able 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 acute care settings, potentially reducing ongoing neurologic injury.

Plain Language Summary

Prolonged seizures in pediatric patients can cause death. Children can have seizures that are happening in the brain, but cannot be seen physically. They can be diagnosed by a machine that records the brain's electrical activity and the data can be interpreted by a specialized neurologist, but the process of getting the machine connected to the patient and getting the data often takes hours and delays diagnosis. This study evaluated a new machine called the Ceribell® and determined that it facilitated a much faster diagnosis than the conventional machine in children and helped the bedside physician interpret the data quickly.