Prevalence of non-convulsive seizure and other electroencephalographic abnormalities in ED patients with altered mental status

Shahriar Zehtabchi, Samah G. Abdel Baki, Ahmet Omurtag, Richard Sinert, Geetha Chari, Shweta Malhotra, Jeremy Weedon, André A. Fenton, Arthur C. Grant

Research output: Contribution to journalArticle

Abstract

Four to ten percent of patients evaluated in emergency departments (ED) present with altered mental status (AMS). The prevalence of non-convulsive seizure (NCS) and other electroencephalographic (EEG) abnormalities in this population is unknown. Objectives To identify the prevalence of NCS and other EEG abnormalities in ED patients with AMS. Methods A prospective observational study at 2 urban ED. Inclusion: patients ≥ 13 years old with AMS. Exclusion: An easily correctable cause of AMS (e.g. hypoglycemia). A 30-minute standard 21-electrode EEG was performed on each subject upon presentation. Outcome: prevalence of EEG abnormalities interpreted by a board-certified epileptologist. EEGs were later reviewed by 2 blinded epileptologists. Inter-rater agreement (IRA) of the blinded EEG interpretations is summarized with κ. A multiple logistic regression model was constructed to identify variables that could predict the outcome. Results Two hundred fifty-nine patients were enrolled (median age: 60, 54% female). Overall, 202/259 of EEGs were interpreted as abnormal (78%, 95% confidence interval [CI], 73-83%). The most common abnormality was background slowing (58%, 95% CI, 52-68%) indicating underlying encephalopathy. NCS (including non-convulsive status epilepticus [NCSE]) was detected in 5% (95% CI, 3-8%) of patients. The regression analysis predicting EEG abnormality showed a highly significant effect of age (P <.001, adjusted odds ratio 1.66 [95% CI, 1.36-2.02] per 10-year age increment). IRA for EEG interpretations was modest (κ: 0.45, 95% CI, 0.36-0.54). Conclusions The prevalence of EEG abnormalities in ED patients with undifferentiated AMS is significant. ED physicians should consider EEG in the evaluation of patients with AMS and a high suspicion of NCS/NCSE.

Original languageEnglish (US)
Pages (from-to)1578-1582
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume31
Issue number11
DOIs
StatePublished - Nov 2013

ASJC Scopus subject areas

  • Emergency Medicine

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