The role of EEG in the emergency department: Its contribution to the patient’s diagnostic–therapeutic pathway. The EMINENCE study

Objectives: To investigate the utility of the emergency electroencephalogram(emEEG) in the diagnostic work-up of patients admitted to the Emergency Department(ED). Methods: Data from consecutive patients admitted to the ED during a 1-year period. We evaluated the usefulness of emEEGs based on the subsequent patient clinical management. Results: 1125 emEEGs from 1018 patients were analyzed. The overall usefulness of an emEEG was 86.7%, mainly influenced by its contribution to diagnosis(75.0%), often excluding initial working diagnosis(50.0%), and to patient management(78.0%). EmEEGs showed their best overall usefulness in Status Epilepticus(SE) and altered level of consciousness both in contributing to the final diagnosis and in patient management and therapeutic pathway. In speech and cognitive/behavioural disorders, emEEGs contributed to the diagnosis(80.6% and 79.8%, respectively), often excluding the initial suspicion of seizures/SE. Normal emEEGs contributed to diagnosis(79.0%), patient management(87.0%) and discharge to home(82.0%). Conclusions: In ED, attending physicians have to make quick decisions about the diagnostic–therapeutic management of patients, and also the ruling out of the initial diagnosis and safely discharging the patient to home are also important goals. Significance: This study provides valuable guidance to ED clinicians in selecting patients for an emEEG and evaluates its contribution to their diagnostic–therapeutic management.