Abstract Details

Title Improved Access to Rapid Electroencephalography at a Community Hospital Reduces Inter-Hospital Transfers for Suspected Non-Convulsive Seizures

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P6 - Poster Session 6 (5:30 PM-6:30 PM)

Poster/Presentation
Number 10-003

Background Patients with suspected non-convulsive seizures are optimally evaluated with EEG. However, limited access to EEG infrastructure at community hospitals often necessitates transfer for LTM. Novel point-of-care EEG systems, such as Rapid Response EEG System (Rapid-EEG; Ceribell Inc.), could expand EEG capability, guide initial management of non-convulsive seizures, and triage appropriate transfers for LTM.

Objective Describe the impact of rapid access to electroencephalography (EEG) and remote expert interpretation (tele-EEG) on rates of inter-hospital transfer for long-term EEG monitoring (LTM).

Design/Methods We retrospectively identified a patient cohort that underwent Rapid-EEG monitoring at a community hospital. Rapid-EEGs were initially reviewed on-site by the community hospital neurologist before transitioning to tele-EEG review by epileptologists at an affiliated academic hospital. We compared the number of patients transferred for LTM against the number of patients who would historically have been transferred if rapid access to EEG was unavailable.

Results Seventy-four patients underwent a total of 118 Rapid-EEG studies (10 seizures, 18 highly epileptiform patterns, 90 slow/normal activity). Eighty-one studies (69%), including 9 of 10 that detected seizures, occurred after-hours when EEG was previously unavailable. Rapid-EEG obviated transfer in 31 of 33 patients (94%) identified as potential transfers for LTM by applying historical practice patterns to our cohort; both completed inter-hospital transfers occurred before transitioning to tele-EEG review.

Conclusions Rapid-EEG increased EEG capability in a community hospital, detected seizures that would otherwise have been missed, and obviated the need for transfer for LTM. We estimate that the reduction in inter-hospital transportation costs alone would be in excess of $39,000 ($1,274 per patient). Point-of-care EEG systems may support a hub-and-spoke model for managing non-convulsive seizures (similar to that utilized in this study and analogous to existing acute stroke infrastructures), with increased EEG capacity at community hospitals and tele-EEG interpretation by specialists at academic hospitals that can accept transfers for LTM.

Authors/Disclosures
Kapil Gururangan, MD (Northwestern University) PRESENTER	Dr. Gururangan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell Inc. Dr. Gururangan has stock in Ceribell Inc. The institution of Dr. Gururangan has received research support from NIH-NINDS. The institution of Dr. Gururangan has received research support from Leon Levy Foundation.
Evan Madill, MD (Mass General Brigham)	The institution of Dr. Madill has received research support from American Academy of Neurology.
Prashanth Krishnamohan, MD (Stanford Stroke Center)	Dr. Krishnamohan has nothing to disclose.