Uses and abuses of paediatric electroencephalography.
OBJECTIVE
To investigate whether requests for standard paediatric electroencephalograms accord with guideline recommendations, subsequent changes in clinical management according to reported results, and extent to which the service meets waiting time targets.


METHODS
Case series.


METHODS
Regional hospital, Hong Kong.


METHODS
All patients aged less than 18 years who underwent electroencephalography between December 2009 and February 2010.


METHODS
Appropriateness of the electroencephalogram request and the impact of its findings on clinical management.


RESULTS
A total of 109 patients were recruited, but requests for standard electroencephalograms were considered 'inappropriate' with respect to guidelines in 44% of the patients, of which 50% were made to diagnose 'funny turns'. The standard electroencephalogram contributed to the diagnosis or management in only 28% of patients. In all of the latter, the request for an electroencephalogram had been appropriate. Nonspecialists made referrals for 86% of the patients. Inadequate information was provided in 66% of the requests. Standard electroencephalograms were performed within guideline targets, the wait being less than 4 weeks in 95% of requests.


CONCLUSIONS
An effective electroencephalogram service was being provided, though abuses were common. These were mainly because of misconceptions regarding the role and limitations of standard electroencephalograms. Through an educative, non-confrontational approach, and with time to explain guideline recommendations to clinicians, sustainable change in practice could be achieved so as to benefit patients, clinicians, and service provision.
Department of Paediatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.
W C
WC
Lee
S S
SS
Man
K W
KW
Lau
L C
LC
Cheng
N S
NS
Kwong
Karen L
KL
Kwong
D000293:Adolescent; D002648:Child; D004569:Electroencephalography / Q000706:statistics & numerical data*; D006723:Hong Kong; D006767:Hospitals, District / Q000706:statistics & numerical data; D006801:Humans; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013997:Time Factors; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review