Diagnostic Yield of EEG Studies Ordered for Syncope by Non-Neurologists vs. Neurologists at a University Medical Center (P02.240)

OBJECTIVE: To determine the difference in the diagnostic yield of an EEG ordered by a non-neurologist compared to a neurologist in patients presenting with syncope. 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: 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: 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: 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. Disclosure: Dr. Gupta has nothing to disclose. Dr. Coyle has received personal compensation for activities with Acorda Therapeutics, Bayer, Biogen Idec, Genentech, Inc., Novartis, Pfizer Inc, Questcor, Roche Diagnostics Corporation, Sanofi-Aventis Pharmaceuticals Corporation, and Teva Neuroscience. Dr. Coyle has received personal compensation in an editorial capacity for NEURA. Dr. Coyle has received research support fromActelion, EMD Serono, and Novartis. Dr. Miller-Horn has nothing to disclose.