Assessing the Value of Interhospital Transfer for Patients with Suspected Status Epilepticus (SE) (4255)

Objective: To assess the frequency at which refractory seizures are detected by continuous EEG monitoring (CEEG) in patients transferred for management of suspected status epilepticus (SE). Background: Patients presenting with suspected SE are often transferred to CEEG-equipped tertiary care facilities to detect nonconvulsive seizures refractory to medication and inform decisions to increase antiepileptic doses and/or refer for surgical intervention. But when no such refractory seizures are present, interhospital transfer is unlikely to provide clinical benefit, thus exposing critically ill patients to the risk and burden of transfer unnecessarily and inefficiently allocating tertiary care beds. No studies have explored the rate at which CEEG detects refractory seizure activity in suspected SE patients after transfer. Design/Methods: We conducted a retrospective chart review on adults (≥18 yrs.) transferred to Mount Sinai Hospital between 1/1/17 and 10/1/19 for management of SE. Reports of CEEG studies conducted within 72 hours of MSH admission were examined for seizures and findings consistent with SE. Admission and discharge times were reviewed. Patients without CEEG reports were excluded. Results: 27 patients were identified, with a median age of 61. 7 (25.9%) displayed electrographic seizures, and 3 (11.1%) displayed EEG patterns consistent with SE. The remaining 24 “non-SE” patients were hospitalized on average for 13.9 days after transfer, and 5.0 of those days (36%) were spent in the neurosurgical ICU. They underwent an average of 64.3 hours (SD 45.9) of CEEG monitoring during their hospital stay. Conclusions: Patients transferred for suspected SE often do not exhibit refractory seizure activity on CEEG after interhospital transfer, suggesting that transfer may not have provided clinical benefit. Improving access to routine EEG monitoring and/or remote EEG interpretation by epileptologists to rule out subclinical seizures may prevent unnecessary transfers, allocate tertiary care beds more efficiently, and allow patients to receive care closer to home. Disclosure: Dr. Cossentino has nothing to disclose. Dr. Dangayach has nothing to disclose. Dr. Liang has nothing to disclose. Dr. Lay has nothing to disclose. Dr. Reynolds has nothing to disclose. Dr. Kellner has nothing to disclose. Dr. Reilly has nothing to disclose. Dr. Research Group has nothing to disclose.