Continuous or emergent EEG: can bedside caregivers recognize epileptiform discharges?
OBJECTIVE
When emergent or continuous EEG monitoring is carried out to detect subclinical seizures, expert interpretation of the results is usually not immediately available. We assessed the ability to recognize epileptiform discharges among various nonexpert bedside caregivers. A second objective was to determine whether such skill improves with a simple educational intervention.


METHODS
A prospective cohort study with an educational intervention in a university-based tertiary medical center.


METHODS
All 125 neurology and neurosurgery residents, intensive care fellows, critical care and neurological floor nurses, and EEG technicians were offered participation. Of these, 50 completed the study and provided 2,398 EEG responses.


METHODS
A computer-based PowerPoint lecture designed to teach recognition of epileptiform discharges.


RESULTS
(a) Average number of correct responses in identifying epileptiform discharges in a computer-based pre-test consisting of 24 EEG questions. (b) Impact of the educational intervention as measured by change in the mean average score in a similar post-test. The rate of correct responses by group ranged from 46% for medical critical care nurses to 94% for EEG technicians. Overall mean correct response rate was 14.72 (61%) for the pre-test, and increased to 16.06 (67%) in for post-test (p=0.002).


CONCLUSIONS
Recognition of epileptiform discharges by bedside caregivers is disturbingly low. A simple educational intervention only modestly improved such ability. Therefore we should not rely on nontrained personnel to interpret emergent or continuous recordings. EEG technicians are an exception, and their skill could be utilized during emergent studies.
Leira
Enrique C
EC
Souers Stroke Institute, Department of Neurology, Saint Louis University, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA. leiraec@slu.edu.
Bertrand
Mary E
ME
Greater Midwest Epilepsy Treatment Center, Department of Neurology, Saint Louis University, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA.
Hogan
R Edward
RE
Greater Midwest Epilepsy Treatment Center, Department of Neurology, Saint Louis University, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA.
Cruz-Flores
Salvador
S
Souers Stroke Institute, Department of Neurology, Saint Louis University, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA.
Wyrwich
Kathleen W
KW
Department of Research Methodology and School of Public Health, Saint Louis University, 3545 Lafayette Ave, St. Louis, MO, 63104, USA.
Albaker
Osamah J
OJ
Souers Stroke Institute, Department of Neurology, Saint Louis University, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA.|Ibn-Sina Hospital, Safat, Kuwait.
Holzemer
Eve M
EM
Souers Stroke Institute, Department of Neurology, Saint Louis University, 3635 Vista Ave at Grand Blvd, St. Louis, MO, 63110, USA.
D015331:Cohort Studies; D003936:Diagnosis, Computer-Assisted; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis*; D006801:Humans; D010564:Personnel, Hospital / Q000592:standards; D011446:Prospective Studies