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Evaluating the utility of Rapid Response EEG in emergency care
  1. Norah M K Wright1,
  2. Evan S Madill2,
  3. Derek Isenberg1,
  4. Kapil Gururangan3,
  5. Hannah McClellen4,
  6. Samuel Snell4,
  7. Mercedes P Jacobson5,
  8. Nina T Gentile1,
  9. Prasanthi Govindarajan6
  1. 1 Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
  2. 2 Neurology, Stanford University School of Medicine, Stanford, California, USA
  3. 3 Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  4. 4 Emergency Services, Stanford Health Care, Stanford, California, USA
  5. 5 Neurology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
  6. 6 Emergency Medicine, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Prasanthi Govindarajan, Emergency Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA; pgovinda{at}stanford.edu

Abstract

Background Timely management of non-convulsive status epilepticus (NCSE) is critical to improving patient outcomes. However, NCSE can only be confirmed using electroencephalography (EEG), which is either significantly delayed or entirely unavailable in emergency departments (EDs). We piloted the use of a new bedside EEG device, Rapid Response EEG (Rapid-EEG, Ceribell), in the ED and evaluated its impact on seizure management when used by emergency physicians.

Methods Patients who underwent Rapid-EEG to rule out NCSE were prospectively enrolled in a pilot project conducted at two ED sites (an academic hospital and a community hospital). Physicians were surveyed on the perceived impact of the device on seizure treatment and patient disposition, and we calculated physicians’ sensitivity and specificity (with 95% CI) for diagnosing NCSE using Rapid-EEG’s Brain Stethoscope function.

Results Of the 38 patients enrolled, the one patient with NCSE was successfully diagnosed and treated within minutes of evaluation. Physicians reported that Rapid-EEG changed clinical management for 20 patients (53%, 95% CI 37% to 68%), primarily by ruling out seizures and avoiding antiseizure treatment escalation, and expedited disposition for 8 patients (21%, 95% CI 11% to 36%). At the community site, physicians diagnosed seizures by their sound using Brain Stethoscope with 100% sensitivity (95% CI 5% to 100%) and 92% specificity (95% CI 62% to 100%).

Conclusion Rapid-EEG was successfully deployed by emergency physicians at academic and community hospitals, and the device changed management in a majority of cases. Widespread adoption of Rapid-EEG may lead to earlier diagnosis of NCSE, reduced unnecessary treatment and expedited disposition of seizure mimics.

  • neurology
  • epilepsy
  • emergency care systems
  • emergency departments
  • emergency department management
  • critical care transport
  • intensive care

Data availability statement

Data are available on reasonable request. The deidentified patient data have been shared with the sponsor and the investigators have access to it. This is not an open access data but we can work with our institutions to release data as needed.

https://doi.org/10.1136/emermed-2020-210903

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    Data availability statement

    Data are available on reasonable request. The deidentified patient data have been shared with the sponsor and the investigators have access to it. This is not an open access data but we can work with our institutions to release data as needed.

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    Footnotes

    • Handling editor Ed Benjamin Graham Barnard

    • Twitter @NinaGentileMD, @PrashaG2017

    • NMKW and ESM contributed equally.

    • Contributors PG, ESM, DI, MPJ and NTG conceived and designed the project. PG and NMKW obtained research funding. PG and NG provided statistical advice on project design and analysed the data. NMKW and ESM drafted the manuscript, and all authors contributed substantially to its revision. PG takes responsibility for the paper as a whole.

    • Funding This project was partially funded by Ceribell (at Stanford University) and the SAEM/RAMS Resident Research Grant (RF2019-009).

    • Competing interests KG serves as a scientific advisor and consultant to Ceribell Inc., which is commercialising Rapid Response EEG for clinical use.

    • Provenance and peer review Not commissioned; externally peer reviewed.