EEG recorded by nurses in emergency department: observational study of 100 patients with suspected seizures

Background: Prompt electroencephalography (EEG) analysis is an essential tool to diagnose suspected seizures. However, EEG is often only available in emergency departments (EDs) during office hours, due to the lack of trained EEG professionals. The primary aim of this pilot study was to examine whether trained ED nurses were able to perform good quality EEGs and if immediate EEG recordings improved patient treatment times. Methods: In this retrospective observational study, we analyzed data of 100 consecutive ED nurse recorded EEGs of ED patients. Data were gathered from the hospital’s electronic health records and the EEG archive. In addition to medical data, special attention was given to the median door-to-EEG time and the quality of EEGs’. Results: A total of 100 patients (49 females) with a mean age was 62.4 years were included in this study. The most common medical patient history was hypertension (n = 46), stroke (n = 34) and epilepsy (n = 27). The quality of each EEG recording taken by EEG-registered ED nurses was sufficient to interpret the results and set the diagnosis. Two patients were excluded from analyzing time intervals because for them EEG recording was not initially indicated at their ED visit. The median door-to-EEG time (n = 98) was 2.85 hours (the interquartile range, IQR 1.55 and 5.05) ranging between 0.28 and 20.88 hours. Abnormal EEGs were found in 76 patients. Amongst these, n = 6 were diagnosed with status epilepticus, and n = 7 were found to have new epilepsy. Conclusions: Our results indicate that EEG-registered ED nurses were able to record all 100 EEGs successfully. Furthermore, the median door-to-EEG time interval was shorter than reported earlier studies. Based on our results, educating and registering ED nurses to perform EEG is worthwhile to achieve prompt initiation of targeted treatments for patients with suspected seizures.