Economic Review of Point-of-Care EEG

Point-of-care EEG (POC-EEG) is an acute care bedside screening tool for the identification of nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE). The objective of this narrative review is to describe the economic themes related to POC-EEG in the United States (US). We examined peer-reviewed, published manuscripts on the economic findings of POC-EEG for bedside use in US hospitals, which included those found through targeted searches on PubMed and Google Scholar. Conference abstracts, gray literature offerings, frank advertisements, white papers, and studies conducted outside the US were excluded. Twelve manuscripts were identified and reviewed; results were then grouped into four categories of economic evidence. First, POC-EEG usage was associated with clinical management amendments and antiseizure medication reductions. Second, POC-EEG was correlated with fewer unnecessary transfers to other facilities for monitoring and reduced hospital length of stay (LOS). Third, when identifying NCS or NCSE onsite, POC-EEG was associated with greater reimbursement in Medical Severity-Diagnosis Related Group coding. Fourth, POC-EEG may lower labor costs via decreasing after-hours requests to EEG technologists for conventional EEG (convEEG). We conducted a narrative review, not a systematic review. The studies were observational and utilized one rapid circumferential headband system, which limited generalizability of the findings and indicated publication bias. Some sample sizes were small and hospital characteristics may not represent all US hospitals. POC-EEG studies in pediatric populations were also lacking. Ultimately, further research is justified. POC-EEG is a rapid screening tool for NCS and NCSE in critical care and emergency medicine with potential financial benefits through refining clinical management, reducing unnecessary patient transfers and hospital LOS, improving reimbursement, and mitigating burdens on healthcare staff and hospitals. Since POC-EEG has limitations (i.e., no video component and reduced montage), the studies asserted that it did not replace convEEG.

床旁即时脑电图（Point-of-care EEG，POC-EEG）是一款用于急性护理的床旁筛查工具，旨在识别非惊厥性发作（nonconvulsive seizures，NCS）与非惊厥性癫痫持续状态（nonconvulsive status epilepticus，NCSE）。本叙述性综述的目标在于阐述美国境内与床旁即时脑电图相关的经济学主题。本研究通过PubMed与Google Scholar进行定向检索，纳入了有关美国医院床旁应用床旁即时脑电图的经济学研究结果的同行评议已发表论文；同时排除了会议摘要、灰色文献、商业广告、白皮书以及美国境外开展的相关研究。最终共纳入12篇论文并进行综述，其研究结果被划分为四类经济学证据：其一，床旁即时脑电图的使用与临床诊疗方案调整及抗癫痫药物用量减少存在关联；其二，床旁即时脑电图的应用与更少的患者跨机构转运监测需求以及更短的住院时长（length of stay，LOS）相关；其三，在院内识别非惊厥性发作或非惊厥性癫痫持续状态时，床旁即时脑电图的使用与疾病严重程度诊断相关分组（Medical Severity-Diagnosis Related Group，MS-DRG）编码下更高的医保报销额度存在关联；其四，床旁即时脑电图可通过减少非工作时段向脑电图技师提出的常规脑电图（conventional EEG，convEEG）检测需求，降低人力成本。本研究为叙述性综述，而非系统性综述。纳入的研究均为观察性研究，且仅采用了一种快速环形头带式检测系统，这限制了研究结果的外推性，并提示存在发表偏倚；部分研究的样本量较小，且所纳入医院的特征未必能代表美国所有医院；针对儿科人群的床旁即时脑电图研究也较为匮乏。综上，仍需开展更多相关研究。床旁即时脑电图是一种用于重症监护与急诊医学领域的非惊厥性发作及非惊厥性癫痫持续状态快速筛查工具，其可通过优化临床诊疗流程、减少不必要的患者跨机构转运与住院时长、提升医保报销额度以及减轻医护人员与医院的工作负担，从而带来潜在的经济效益。由于床旁即时脑电图存在一定局限（如无视频记录模块、导联配置受限），相关研究表明其无法替代常规脑电图。