Current Practice in Administration and Clinical Criteria of Emergent EEG

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Abstract
Policies of administration and availability of EEG offeredduring nonbusiness hours vary widely among EEG laboratories. The authorssurveyed medical directors of accredited EEG laboratories (n = 84) todetermine the ranges of availability and clinical indications for approval ofcontinuously available emergent EEG (E-EEG). Of 46 respondents, 37 (80%)offered E-EEG. Two centers recently lost funding for E-EEG. Availability wasnot associated with the total number of EEGs performed annually. The meanestimated response time from request to expert interpretation was 3 ± 4hours (range, 1–24 hours). The five clinical indications for which mostrespondents approved E-EEGs were possible nonconvulsive status epilepticus(100%), treatment of status epilepticus (84%), cerebral death exam (81%),diagnosis of convulsive status epilepticus (79%), and diagnosis of coma orencephalopathy (70%). Respondents disagreed widely when asked which clinicalsituations merited E-EEG, with some approving all requests and others denyingall except for nonconvulsive status epilepticus. The wide range of currentpractice suggests that research focused on outcomes of aggressive, EEG-aidedpatient evaluation and treatment are needed to define better the costs andbenefits of a continuously available EEGservice.