E-Learning for Pediatric Emergency Department Staff in Point-of-Care Electroencephalogram Interpretation: Prospective Cohort Study.

Abstract

Background: Status epilepticus (SE) represents a critical pediatric emergency necessitating prompt treatment and monitoring. The diagnosis of nonconvulsive SE and the monitoring of convulsive SE require electroencephalogram (EEG) recordings. The integration of simplified point-of-care EEG may improve care in pediatric emergency departments.

Objective: This study aims to assess the efficacy of an electronic EEG self-learning module for improving the interpretation of normal cortical activity, artifacts, and seizure patterns in point-of-care EEG by pediatric emergency medicine (PEM) providers.

Methods: This prospective cohort study was conducted in a tertiary academic pediatric emergency department and primarily targeted senior medical staff while also engaging junior medical staff and registered nurses. A novel EEG e-learning module trained participants to identify normal cortical activity, artifacts, and seizure patterns. The study comprised pretest, posttest, and 3-month retention assessments to evaluate the EEG total score as its primary outcome and basic EEG knowledge and confidence measures as secondary outcomes. Outcomes were analyzed using mixed-effects proportional odds logistic regression models.

Results: Of 102 PEM providers invited, 61 individuals participated (25 senior medical staff, 15 junior medical staff, and 21 registered nurses), and 29 finished the 3-tiered study. In finishers, the EEG total score (max=12 points), indicative of accurate EEG classification, increased substantially between pretest and posttest from a median of 7 (IQR 5-8) to 10 (IQR 7-11) points, corresponding with an increase in the odds of achieving higher EEG total scores at the posttest (odds ratio 24.18, 95% CI 7.398-79.043, P<.001). At the retention test, the EEG total score remained elevated, although to a lesser extent (median 8 points [IQR 6-9]). Similar trends were observed in secondary outcomes.

Conclusions: The implementation of an e-learning EEG module improved the ability of PEM providers to interpret EEGs. This study highlights the feasibility of imparting basic EEG skills to nonexperts through targeted educational interventions. However, the sustained retention of such skills requires improvement, emphasizing the necessity for ongoing refresher training.