Utility of electroencephalography in the pediatric emergency department

To assess the role of electroencephalography (EEG) in the pediatric emergen cy department, we reviewed the records of all patients having an EEG in the pediatric emergency department of our hospital between 1995 and 1997. EEG findings, clinical presentations, and follow-up data were analyzed, and pat ients were distributed into three groups according to clinical presentation : group 1 included patients with new-onset seizures, group 2 included patie nts with known epilepsy presenting with worsening seizures and altered ment ation, and group 3 comprised patients with acute confusional states. Overal l, 56 patients with 57 EEGs were included. In group 1 (n = 36), 20 (55.6%) had an abnormal EEG. The risk of recurrence was much higher in children wit h abnormal EEGs (80% vs. 31%) (P < .01). In retrospect, among all of the pa tients receiving the diagnosis of epilepsy, 76% had an abnormal emergency d epartment EEG. Four in group 2 (n = 14) and one in group 3 (n = 7) were pro ven to have nonconvulsive status epilepticus and were treated accordingly. No patients in group 1 had nonconvulsive status epilepticus. Ongoing seizur es were promptly excluded in the remainder. The EEG directly contributed to the diagnosis in 84% of all referrals in the pediatric emergency departmen t, either being abnormal and leading to a diagnosis of a seizure disorder o r confirming low suspicion for seizures. Thus, a prompt EEG should be consi dered in children with new-onset seizures and unexplained altered conscious ness.