Economic review of point-of-care EEG

Abstract

Aims: Point-of-care electroencephalogram (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).

Materials and methods: 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.

Results: 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).

Limitations: 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.

Conclusions: 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.

Keywords:

• Nonconvulsive seizure
• critical care
• point-of-care EEG
• rapid-EEG
• economic themes
• reimbursement
• healthcare burdens

JEL Classification Codes:

• A10
• I10

Transparency

Declaration of financial/other interests

AG is a paid consultant for Ceribell, Inc. MEW is a paid employee of Costello Medical Consulting, Inc., who was contracted by Ceribell, Inc. to provide medical writing assistance. JPN is a paid consultant for Ceribell, Inc., an advisor for Forsquare Consulting, and has consulted for Potrero, Inc. and Briova RX.

Author contributions

AG, MEW, and JPN had substantial contributions to conception, design, analysis, and interpretation of the data, drafted the paper or reviewed it critically for intellectual content, had final approval of the version to be published, and agreed to be accountable for all aspects of the work.

Acknowledgements

The authors would like to thank the teams at Ceribell, Inc. and Costello Medical Consulting, Inc. for their guidance and writing assistance.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they have received funds for travel and conference attendance, as well as meals, from Ceribell. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

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Funding

This review was sponsored by Ceribell, Inc. Support for third-party writing assistance for this article, provided by Costello Medical Consulting, Inc., was funded by Ceribell, Inc. in accordance with Good Publication Practice (GPP 2022) guidelines (https://www.acpjournals.org/doi/10.7326/M22-1460).