048 The indications and utility of electroencephalogram, an audit of hospital practices

Objectives The MBS taskforce recommends discouraging use of electroencephalogram (EEG) investigations for low yield indications without neurological specialty input. This study aimed to examine the indications and utility of electroencephalogram within a hospital setting. Methods A retrospective audit was undertaken over a 3 month period across two hospitals of adult inpatient EEGs ordered by services other than neurology. Results Data was collected on 236 EEG encounters. 11% of EEGs performed had a definitive diagnosis of seizures on discharge, of these EEGs the report documented; a normal EEG in 7%, epileptiform activity in 19%, and non-specific slowing in 74%. 17% of Adult EEGs were performed for low yield indications. None of these EEGs resulted in change of management nor a diagnosis of seizures. An additional 14% were performed as part of a ‘falls work up,’ none of the EEGs for this indication resulted in a diagnosis of seizure on the discharge summary. Conclusion This audit supports previous findings that EEGs have a low sensitivity and can not be exclusively used to attain a diagnosis. Low yield indications were common within this audit and the EEG was not clinically significant in this group. EEG should not be used to rule out seizures when the clinical suspicion for seizures is near zero and this audit identified an additional low yield category within the hospital setting as part of a ‘falls work up.’ This study supports the conservative use of EEG in line with the MBS funding taskforce protocol.