Use and value of ordering emergency electroencephalograms and videoelectroencephalographic monitoring after business hours in a children's hospital: 1-year experience.

Policies of administration, availability, and utility of ordering emergency electroencephalograms (EEGs) during nonbusiness hours vary widely among different EEG laboratories. In an attempt to explore further the importance of performing such emergency procedures in children, we analyzed the utility of not only emergency EEGs but also emergency longterm bedside EEGs and emergency video-EEGs at our institution in 1 year. The number of EEG studies performed in 1 year at our neurophysiology laboratory was 1821: 1212 routine EEGs, 387 24-hour ambulatory EEGs, 81 video-EEGs, and 141 long-term bedside EEGs. The number of emergency studies during the same period of time was 32 (1.8% of the total studies): 18 emergency EEGs, 8 emergency long-term bedside EEGs, and 6 emergency video-EEGs. The reasons for ordering the 18 emergency EEGs included the evaluation of (1) altered mental status (n=10), (2) paroxysmal movement (including cluster of seizures) (n=6), and (3) prolonged febrile or afebrile seizures prior to being discharged on a weekend (n=2). The eight emergency long-term bedside EEGs were done to evaluate (1) altered mental status (n=6) and (2) frequently occurring paroxysmal events (n=2). Four of the eight emergency long-term bedside EEGs were done after an abnormal emergency EEG. The six emergency video-EEGs were done to evaluate frequently occurring paroxysmal events (n=5) and altered mental status (n=1). Overall, emergency EEGs and emergency video-EEGs were useful in decision making in 30 of 32 (94%) studies. This might be related to the fact that a neurologist approved all of the studies. Appropriate strategies need to be developed to make this essential service available for patient care.