Point-of-care EEG?

Abstract

Point-of-care testing brings diagnostics rapidly to the bedside of patients. A variety of instruments and test kits have gradually made their way into pediatric practice. Transcutaneous bilirubin measurement has been popularized in the newborn nursery. Pulse oximetry and portable ultrasonography are mainstays in the pediatric emergency department (ED). Is there a role in the ED for reduced-lead electroencephalography (EEG), somewhat akin to amplitude integrated EEG in the neonatal intensive care unit? In this volume of The Journal, Yamaguchi et al examine retrospectively the proportion of children presenting to a single emergency department with altered mental status who had non-convulsive seizures upon undergoing reduced-lead EEG. In total, 16.9% (41/242) of patients with altered mental status evaluated by reduced-lead EEG had detectable non-convulsive seizures, equivalent to 4.4% (41/932) of all patients with altered mental status. There was a clear selection bias to which children underwent EEG. Over 80% of patients monitored for non-convulsive seizures had a prior history of seizures, often febrile. Although this early, hypothesis-testing study has limitations, the use of reduced-lead EEG monitoring in the ED might facilitate the recognition and treatment of non-convulsive seizures, especially among patients with a history of seizures. A greater application of reduced-lead EEG might possibly chip away at the widespread problem of conventional EEG availability and interpretation. However, a cautious approach is needed before further use of reduced-lead EEG, as validation studies and additional research are needed. Article page 213 ▶ Nonconvulsive Seizure Detection by Reduced-Lead Electroencephalography in Children with Altered Mental Status in the Emergency DepartmentThe Journal of PediatricsVol. 207PreviewTo evaluate the proportion of children presenting to the emergency department (ED) with altered mental status who demonstrate nonconvulsive seizures on reduced-lead electroencephalography (EEG), and to further investigate the characteristics, treatment, and outcomes in these patients compared with patients without nonconvulsive seizures. Full-Text PDF