Abstract Details

Title Diagnostic Yield of EEG Studies Ordered for Syncope by Non-Neurologists vs. Neurologists at a University Medical Center

Topic Clinical Neurophysiology

Presentation(s) P02 - (-)

Poster/Presentation
Number 240

Objective

Background BACKGROUND: In evaluating a patient with loss of consciousness (LOC) and tone, the 2007 American College of Emergency Physicians Clinical Policy on Syncope lists history, physical, and ECG as their recommendations. Symptoms prior to LOC in syncope may be similar to seizure, and if the history includes post-event confusion, an EEG may be warranted. However, frequently ordered EEGs regardless of history suggesting syncope, possibly lead to inappropriate utilization of hospital resources.

Design/Methods DESIGN/METHODS: Subjects were identified through a search of "syncope" in ER and inpatient routine EEG reports done 1/2011 to 6/2012. Data collected included age and gender, EEG results, and ordering physician. Charts were reviewed to confirm history.

Results RESULTS: EEG reports of 177 patients were identified. Average age 58 years, range 3-92 years, 107 males, 70 females. One-hundred-nineteen(67%) EEGs were normal, 58(33%) abnormal. Slowing was seen in 45/58(78%) of abnormal EEGs, 1 breach, 1 FIRDA. Only 11/177(6%) showed epileptiform discharges (3 generalized spike-wave, 2 right temporal sharp-waves, 2 left temporal sharp-waves, 1 right frontal sharp-waves, 1 PLEDS, 1 notched-slowing, and 1 with subclinical-seizures). Neurologists ordered 45/177(25%) of EEGs, 132/177(75%) ordered by non-neurologists. Of the neurologist-ordered EEGs, 8/45(18%) showed epileptiform activity, 3/132(2%) EEGs ordered by non-neurologists were epileptiform.

Conclusions CONCLUSIONS: Our data agrees, EEG is not very useful for evaluating syncope because of its low diagnostic yield. However, our study revealed that EEGs ordered by neurologists have a higher likelihood of showing epileptiform discharges. Prospective studies are needed to clarify the role of neurologists in ordering EEGs for patients with syncope, to minimize inappropriate utilization of hospital resources.

Authors/Disclosures
Nidhi Gupta, MD (MAMPG) PRESENTER	No disclosure on file
Patricia K. Coyle, MD, FAAN (SUNY At Stony Brook)	Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Accordant. Dr. Coyle has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Coyle has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Sanofi Genzyme. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GlaxoSmithKline. Dr. Coyle has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon Therapeutics. The institution of Dr. Coyle has received research support from CorEvitas LLC. The institution of Dr. Coyle has received research support from Genentech/Roche. The institution of Dr. Coyle has received research support from NINDS. The institution of Dr. Coyle has received research support from Sanofi Genzyme. The institution of Dr. Coyle has received research support from Cleveland Clinic.
Jill Miller-Horn, MD (SUNY Stony Brook)	Dr. Miller-Horn has nothing to disclose.
Sheryl Martin-Schild, MD, PhD, FAAN (Dr. Brain, Inc.)	No disclosure on file

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