Economic review of point-of-care EEG

Figures & data

Figure 1. Overview of study design.

ConvEEG, Conventional electroencephalogram; EEG, Electroencephalogram; POC-EEG, Point-of-care electroencephalogram; US, United States.

Table 1. Summary of included studies.

				Main Economic or Potentially Economic Findings Cited for POC-EEG on:
Author(s)	Journal and Publication Year	Study Type	Study Population (Patients)	Refining Clinical Management	Reducing Unnecessary Patient Transfers and Hospital LOS	Improving Reimbursement	Mitigating Burdens on Healthcare Staff and Hospitals
Eberhard and Beckerman^47	J Neurosci Nurs (2023)	Retrospective cohort	102	–	LOS decreased by 3 days; almost $740,000 in potential annual savings	10 additional DRGs “with MCC/CC” billed; nearly $146,000 in potential annual gain	–
Hobbs et al.^43	Neurocritic Care (2018)	Prospective cohort	34	Clinical management amended in 40% of suspected NCSE cases; fewer ASMs prescribed (p = 0.01)	–	–	POC-EEG user-friendliness
Kamousi et al.^40	Neurocritic Care (2021)	Retrospective cohort	353	–	–	Potential additional DRG “with MCC/CC” billing	–
Kozak et al.^44	J Am Coll Emerg Physicians Open (2023)	Retrospective cohort	157	Clinical management amendments correlated with POC-EEG findings (p < 0.001)	ED (p = 0.04) and hospital (p < 0.001) LOS associated with door-to-EEG time^a	–	Extended EEG coverage with POC-EEG
Kurup et al.^55	Epileptic Disord (2022)	Retrospective chart review	100	Decreased probability of initiation/ continuation of ASMs (Χ^2 = 7.086, p = 0.0078)	–	–	–
LaMonte^50	Epilepsia Open (2021)	Prospective cohort with retrospective controls	50	Decreased overtreatment for 90% of patients concerning for SE	–	–	Diminished after-hours EEG technologist labor (p = 0.02); healthcare staff positively commented on POC-EEG impact
Madill et al.^57	Epileptic Disord (2022)	Retrospective cohort	74	–	After POC-EEG implementation, only 6% of patients were transferred offsite for EEG; >$39,000 in ground transportation savings	Potential to decrease reimbursement lost to other hospitals	Extended EEG coverage with POC-EEG
Vespa et al.^23	Crit Care Med (2020)	Prospective multicenter nonrandomized observational	181^b	Adjusted treatment decision in 20% of cases; projected 51% decrease in parenteral ASM treatments and intubations^c	ICU and hospital LOS decreased by 0.4 and 1.2 days, respectively; $3,971/POC-EEG use saved^c	–	POC-EEG user-friendliness
Ward et al.^46	Front Digit Health (2023)	Prospective cohort with retrospective controls	88^d	–	Reduced transfer rate to 1.1 transfers/month; >$37,000 in potential annual savings and potential gain of nearly $14,000/non-transferred patient	Potential to decrease reimbursement lost to other hospitals; greater amount collected ($11,161) by hospitals for non-transferred patients assessed with POC-EEG	–
Wright et al.^54	Emerg Med J (2021)	Prospective cohort	38	Impacted clinical management in 53% of suspected NCSE cases	–	–	–
Yazbeck et al.^42	J Neurosci Nurs (2019)	Prospective cohort	10	De-escalated antiseizure treatment in 40% of patients	–	–	POC-EEG user-friendliness

ASM, Antiseizure medication; DRG, Diagnosis related group; ED, Emergency department; EEG, Electroencephalogram; ICU, Intensive care unit; LOS, Length of stay; MCC/CC, Major complication or comorbidity/complication or comorbidity; NCSE, Nonconvulsive status epilepticus; POC-EEG, Point-of-care electroencephalogram; SE, Status epilepticus.

^aDoor-to-EEG time was defined as time from patients’ first ED evaluation to the initiation of POC-EEG monitoring⁴⁴.

^bThere were missing data for two patients for the refining clinical management analysis²³.

^cProjected treatment decreases, LOS results, and monetary savings were quantified by Ney et al.²⁵.

^dThis was the number of patients assessed with POC-EEG; the number of patients assessed with convEEG (control group) was not provided⁴⁶.

Eberhard E, Beckerman SR. Rapid-response electroencephalography in seizure diagnosis and patient care: lessons from a community hospital. J Neurosci Nurs. 2023;55(5):157–163. doi: 10.1097/JNN.0000000000000715.

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Hobbs K, Krishnamohan P, Legault C, et al. Rapid bedside evaluation of seizures in the ICU by listening to the sound of brainwaves: a prospective observational clinical trial of Ceribell’s brain stethoscope function. Neurocrit Care. 2018; 29(2):302–312. doi: 10.1007/s12028-018-0543-7.

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Kamousi B, Karunakaran S, Gururangan K, et al. Monitoring the burden of seizures and highly epileptiform patterns in critical care with a novel machine learning method. Neurocrit Care. 2021; 34(3):908–917. doi: 10.1007/s12028-020-01120-0.

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Kozak R, Gururangan K, Dorriz PJ, et al. Point-of-care electroencephalography enables rapid evaluation and management of non-convulsive seizures and status epilepticus in the emergency department. J Am Coll Emerg Physicians Open. 2023;4(4):e13004. doi: 10.1002/emp2.13004.

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Kurup D, Davey Z, Hoang P, et al. Effect of rapid EEG on anti-seizure medication usage. Epileptic Disord. 2022;24(5):831–837. doi: 10.1684/epd.2022.1463.

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LaMonte MP. Ceribell EEG shortens seizure diagnosis and workforce time and is useful for COVID isolation. Epilepsia Open. 2021; 6(2):331–338. doi: 10.1002/epi4.12474.

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Madill ES, Gururangan K, Krishnamohan P. Improved access to rapid electroencephalography at a community hospital reduces inter-hospital transfers for suspected non-convulsive seizures. Epileptic Disord. 2022;24(3):507–516. doi: 10.1684/epd.2021.1410.

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Vespa PM, Olson DM, John S, et al. Evaluating the clinical impact of rapid response electroencephalography: the DECIDE multicenter prospective observational clinical study. Crit Care Med. 2020;48(9):1249–1257. doi: 10.1097/CCM.0000000000004428.

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Ward J, Green A, Cole R, et al. Implementation and impact of a point of care electroencephalography platform in a community hospital: a cohort study. Front Digit Health. 2023;5:1035442. doi: 10.3389/fdgth.2023.1035442.

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Wright NMK, Madill ES, Isenberg D, et al. Evaluating the utility of Rapid Response EEG in emergency care. Emerg Med J. 2021;38(12):923–926. doi: 10.1136/emermed-2020-210903.

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Yazbeck M, Sra P, Parvizi J. Rapid response electroencephalography for urgent evaluation of patients in community hospital intensive care practice. J Neurosci Nurs. 2019; 51(6):308–312. doi: 10.1097/JNN.0000000000000476.

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Ney JP, Gururangan K, Parvizi J. Modeling the economic value of Ceribell Rapid Response EEG in the inpatient hospital setting. J Med Econ. 2021; 24(1):318–327. doi: 10.1080/13696998.2021.1887877.

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