Effect of microEEG on clinical management and outcomes of emergency department patients with altered mental status: a randomized controlled trial

Shahriar Zehtabchi, Samah G Abdel Baki, Ahmet Omurtag, Richard Sinert, Geetha Chari, Gholamreza S Roodsari, Jeremy Weedon, André A Fenton, Arthur C Grant, Shahriar Zehtabchi, Samah G Abdel Baki, Ahmet Omurtag, Richard Sinert, Geetha Chari, Gholamreza S Roodsari, Jeremy Weedon, André A Fenton, Arthur C Grant

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 (microEEG) to record standard 30-minute EEGs 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 microEEG 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.

Trial registration: ClinicalTrials.gov NCT01671475.