微脑电图对急诊科意识状态改变患者临床管理和结局的影响：一项随机对照试验。
Effect of microEEG on clinical management and outcomes of emergency department patients with altered mental status: a randomized controlled trial.
机构信息
The Department of Emergency Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY.
出版信息
Acad Emerg Med. 2014 Mar;21(3):283-91. doi: 10.1111/acem.12324.
OBJECTIVES
Altered mental status (AMS) is a common presentation in the emergency department (ED). A previous study revealed 78% electroencephalogram (EEG) abnormalities, including nonconvulsive seizure (NCS; 5%), in ED patients with AMS. The objective of this study was to assess the impact of EEG on clinical management and outcomes of ED patients with AMS.
METHODS
This was a randomized controlled trial at two urban teaching hospitals. Adult patients (≥18 years old) with AMS were included. Excluded patients had immediately correctable AMS (e.g., hypoglycemia) or were admitted before enrollment. Patients were randomized to routine care (control) or routine care plus EEG (intervention). Research assistants used a scalp electrode set with a miniature, wireless EEG device (microEEG) to record standard 30-minute EEGs at presentation, and results were reported to the ED attending physician by an off-site epileptologist within 30 minutes. Primary outcomes included changes in ED management (differential diagnosis, diagnostic work-up, and treatment plan from enrollment to disposition) as determined by surveying the treating physicians. Secondary outcomes were length of ED and hospital stay, intensive care unit (ICU) requirement, and in-hospital mortality.
RESULTS
A total of 149 patients were enrolled (76 control and 73 intervention). Patients in the two groups were comparable at baseline. EEG in the intervention group revealed abnormal findings in 93% (95% confidence interval [CI] = 85% to 97%), including NCS in 5% (95% CI = 2% to 13%). Using microEEG was associated with change in diagnostic work-up in 49% (95% CI = 38% to 60%) of cases and therapeutic plan in 42% (95% CI = 31% to 53%) of cases immediately after the release of EEG results. Changes in probabilities of differential diagnoses and the secondary outcomes were not statistically significant between the groups.
CONCLUSIONS
An EEG can be obtained in the ED with minimal resources and can affect clinical management of AMS patients.
目的
意识状态改变（AMS）是急诊科（ED）常见的表现。先前的研究显示，ED 中 AMS 患者有 78%的脑电图（EEG）异常，包括非惊厥性癫痫发作（NCS；5%）。本研究旨在评估 EEG 对 ED 中 AMS 患者的临床管理和结局的影响。
方法
这是在两家城市教学医院进行的一项随机对照试验。纳入成年（≥18 岁）AMS 患者。排除即刻可纠正的 AMS（如低血糖）或在入组前已入院的患者。患者被随机分为常规护理（对照组）或常规护理加 EEG（干预组）。研究助理使用头皮电极套件和微型无线 EEG 设备（微 EEG）在就诊时记录标准的 30 分钟 EEG，并在 30 分钟内由场外癫痫专家将结果报告给 ED 主治医生。主要结局包括通过调查治疗医生来确定 ED 管理（从入组到出院的鉴别诊断、诊断性检查和治疗计划）的变化。次要结局为 ED 和住院时间、重症监护病房（ICU）需求和院内死亡率。
结果
共纳入 149 例患者（对照组 76 例，干预组 73 例）。两组患者基线特征相似。干预组的 EEG 发现异常率为 93%（95%置信区间 [CI] = 85%至 97%），包括 NCS 占 5%（95% CI = 2%至 13%）。使用微 EEG 与诊断性检查（95% CI = 38%至 60%）和治疗计划（95% CI = 31%至 53%）的改变相关，这两项改变发生在 EEG 结果发布后的即刻。两组间鉴别诊断和次要结局的概率变化无统计学意义。
结论
ED 中可以在最小资源的情况下获得 EEG，并可影响 AMS 患者的临床管理。
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