Clinical selection of point-of-care EEG for seizure or altered mental status in a pediatric emergency department.
BACKGROUND Point-of-care electroencephalography (pocEEG) may help distinguish nonconvulsive status epilepticus from postictal or nonepileptic altered mental status in children. However, its real-world clinical use is not well described. METHODS This single-center retrospective cohort study screened ED visits at a tertiary pediatric emergency department between August 1, 2024, and July 31, 2025. Children aged <18 years presenting with seizure or altered mental status were included if they had ongoing seizure activity, impaired consciousness, reduced responsiveness, or persistent postictal altered mental status on arrival. Factors associated with pocEEG use were evaluated using Firth-penalized multivariable logistic regression. RESULTS Among 163 included children, 72 (44%) underwent pocEEG. Univariable analyses showed associations between pocEEG use and prolonged seizures, ongoing seizure on arrival, reduced Glasgow Coma Scale (GCS) eye-opening response on arrival, history of intracranial disease, and longer seizure duration. In the primary five-variable multivariable model, pocEEG use was independently associated with seizures lasting ≥15 min (adjusted odds ratio [aOR]: 2.95, 95% confidence interval [CI]: 1.48-5.96) and reduced GCS eye-opening response on arrival (aOR: 3.35, 95% CI: 1.60-7.28). Children who underwent pocEEG more frequently received midazolam and phenobarbital and were more often admitted to the pediatric intensive care unit. Nonconvulsive status epilepticus was classified in 10 of 72 monitored children. CONCLUSIONS pocEEG was preferentially used in children with prolonged seizures and reduced GCS eye-opening response on arrival. These findings describe current clinical selection for pocEEG and support prospective studies assessing how pocEEG influences antiseizure medication decisions.