(581) Delays in Access to EEG and Its Impact on Hospital Length of Stay: Cases From the SAFER-EEG Trial

Introduction: Delays in non-convulsive seizure and status epilepticus (NCS/NCSE) diagnosis and treatment, often due to challenges in access to electroencephalographic (EEG) monitoring, have been linked to poor health outcomes (Hill et al., 2017 Ann of Neurology 82(2) 155 – 165). Point-of-care EEG (POC-EEG) allows for rapid access to EEG monitoring at the bedside, facilitating faster detection and management of NCS/NCSE. We set out to contrast the impact of POC-EEG compared to conventional EEG (convEEG) in seizure-positive patients.

Methods: Data were collected as part of a muti-center retrospective study (SAFER-EEG trial) across four academic hospitals. The patients were divided into two cohorts, those who received convEEG only and those who received POC-EEG (alone or followed by convEEG). Patients included in this analysis had a seizure diagnosed by EEG. A sub-analysis included those who had their first seizure within one minute of the start of EEG. We calculated the time from admission to EEG start, and hospital stay from EEG start to discharge.

Results: There were 198 seizure-positive patients (convEEG = 138, POC-EEG = 60). As a group, the seizure-positive convEEG patients waited a median of 5.9 [2.7, 33.7] hrs from admission to the EEG start, while the seizure-positive POC EEG patients’ wait time was a median of 3.6 [0.57, 9.1] hrs.

Of the seizure-positive convEEG patients, 37 (27%) were seizing at the start of recording. The median time to convEEG was 5.7 [2.1, 40.1] hrs, and the median hospital stay after convEEG start was 8.4 [4.6, 15.4] days. In comparison, 10% (6 of 60) of POC EEG patients were seizing at the time the POC EEG was started. The median time to POC-EEG was 0.6 [0.09, 1.3] hrs, and their median stay after POC-EEG start was 2.8 [1.7, 6.7] days.

Conclusions: We found that 27% of patients who only received convEEG were actively seizing when recording was initiated, compared to 10% of POC EEG cases. The POC-EEG cases had shorter time to EEG and shorter hospital stays after the EEG. These observations highlight the issue of delayed access to EEG where seizures are left untreated while waiting for convEEG and show initial evidence of the impact of these delays in length of hospital stay.