Paediatric electroencephalograph: The benefits of guidelines.
AIM
The electroencephalogram (EEG) is an important but often over-relied upon investigation in evaluating paroxysmal events of childhood. The UK National Institute for Health and Care Excellence (NICE) guidelines for epilepsy help clinicians decide which children should/should not have an EEG. Would introduction of these guidelines in our hospital change the ordering practices of our hospital clinicians? Would introduction reduce unnecessary tests and improve rapidity of obtaining an EEG?


METHODS
Paediatric EEG requests, results and, where possible, the patient hospital chart were reviewed before and after introduction of an EEG request form (Appendix I) which provided ordering advice as per the NICE epilepsy guideline. Patient age, sex, distance from hospital and ethnicity were reviewed. Also evaluated was clinical indication and time from ordering to performing the EEG.


RESULTS
Prior to the new EEG form, 56% of the EEG requests fulfilled the NICE criteria; after its introduction, this increased to 83%. EEGs ordered within the NICE guidelines were abnormal on 61% of occasions, but when ordered outside of the guidelines they were abnormal only 4% of the time (P < 0.0001). After its introduction there was poor use of the new form in practice (only 29% of requests). However, the EEGs were more likely to meet ordering criteria and fewer tests were required, leading to more rapid turn-around times.


CONCLUSION
This study demonstrates the value of using guidelines to improve timeliness and reduce over-utilisation of EEGs in general paediatric practice.
['Thompson Nee Milner|Brooke E|BE|', 'Newsom|David|D|', 'White|Andrew|A|']
D000293:Adolescent D001315:Australia D002648:Child D002675:Child, Preschool D015331:Cohort Studies D003430:Cross-Sectional Studies D004569:Electroencephalography D005260:Female D006801:Humans D015994:Incidence D007223:Infant D007231:Infant, Newborn D008297:Male D010372:Pediatrics D017410:Practice Guidelines as Topic D010818:Practice Patterns, Physicians' D015203:Reproducibility of Results D012189:Retrospective Studies D018570:Risk Assessment D012640:Seizures D013997:Time Factors D019564:Unnecessary Procedures
electroencephalograph epilepsy child