Gurbani Neepa S, Gurbani Suresh G, Mittal Meenu, McGuckin Jeanne S, Tin Sue Nwe, Tehrani Keo, Chayasirisobhon Sirichai
Department of Neurology, Kaiser Permanente Medical Center, Anaheim, California 92807, USA.
Clin EEG Neurosci. 2006 Jan;37(1):30-3. doi: 10.1177/155005940603700107.
The objective of this study was to determine if screening by a neurologist of all non-neurologist electroencephalogram (EEG) referrals prior to approval reduces the number of inappropriate requests. This retrospective survey included 600 consecutive EEG requisitions referred to the Anaheim Kaiser Permanente Neurodiagnostic Laboratory to rule out epilepsy. Patients with established epilepsy referred for a repeat EEG for management issues were excluded. Three groups of EEG referrals were analyzed. Each group consisted of 200 EEGs (100 pediatric and 100 adult EEGs). The first group was referred directly by non-neurologists, the second group was referred by non-neurologists with scrutiny by a neurologist, and the third group was referred by a neurologist directly. In the pediatric group, the ratio of abnormal EEG vs normal EEG was 1:3.35 in the first group, 1:0.69 in the second group and 1:0.33 in the third group. In the adult group, the ratio of abnormal EEGs vs normal EEGs was 1:2.23 in the first group, 1:0.82 in the second group and 1:0.45 in the third group. In the combined pediatric and adult groups, the ratio of abnormal EEG vs normal EEG was 1:2.70 in the first group, 1:0.75 in the second group and 1:0.39 in the third group. There was a significant difference between the results of the EEGs ordered by non-neurologists directly versus non-neurologists with scrutiny (p=.334, chi-square test). Scrutiny by a neurologist of EEG referrals from non-neurologists led to a reduction in the number of normal EEG results. This suggests that inappropriate EEG requests for non-epileptic patients that yield normal EEG results are significantly reduced with scrutiny. This can help reduce the indiscriminate overuse of EEGs by non-neurologists thereby leading to better utilization of healthcare resources.
本研究的目的是确定在批准前由神经科医生对所有非神经科医生转诊的脑电图（EEG）检查申请进行筛查是否能减少不适当申请的数量。这项回顾性调查纳入了600例连续转诊至阿纳海姆凯撒医疗机构神经诊断实验室以排除癫痫的EEG申请。因管理问题而被转诊进行重复EEG检查的确诊癫痫患者被排除。对三组EEG转诊申请进行了分析。每组包括200例EEG检查（100例儿科和100例成人EEG）。第一组由非神经科医生直接转诊，第二组由非神经科医生转诊并经神经科医生审查，第三组由神经科医生直接转诊。在儿科组中，第一组异常EEG与正常EEG的比例为1:3.35，第二组为1:0.69，第三组为1:0.33。在成人组中，第一组异常EEG与正常EEG的比例为1:2.23，第二组为1:0.82，第三组为1:0.45。在儿科和成人合并组中，第一组异常EEG与正常EEG的比例为1:2.70，第二组为1:0.75，第三组为1:0.39。非神经科医生直接开出的EEG检查结果与经审查的非神经科医生开出的结果之间存在显著差异（p = 0.334，卡方检验）。神经科医生对非神经科医生转诊的EEG申请进行审查导致正常EEG结果数量减少。这表明，经过审查后，非癫痫患者获得正常EEG结果的不适当EEG申请显著减少。这有助于减少非神经科医生对EEG的滥用，从而更好地利用医疗资源。
