BMJ 2001;322:954-957 ( 21 April )

Papers

Requests for electroencephalography in a district general hospital: retrospective and prospective audit

D Smith, consultant neurologist, ^a R Bartolo, EEG technician, ^b R M Pickles, general practitioner, ^b B M Tedman, consultant neurophysiologist. ^c

^a Department of Neurology, Walton Centre for Neurology and Neurosurgery, Fazakerley, Liverpool L9 7LJ, ^b EEG Department, Wrexham Maelor Hospital, Wrexham LL13 7TD, ^c Department of Neurophysiology, Walton Centre for Neurology and Neurosurgery

Correspondence to: D Smith brown-s{at}wcnn-tr.nwest.nhs.uk

Objectives: To determine the number of inappropriate requests for electroencephalography (EEG) and whether guidelines on use could reduce this number.
Design: Audit with retrospective and prospective components.
Setting: EEG department in district general hospital and centre for neurology and neurosurgery.
Participants: Retrospective: 368 at the general hospital and 143 patients at the neurology centre. Prospective: 241 patients undergoing EEG at the general hospital.
Interventions: Guidelines for EEG issued to users of service at the general hospital.
Outcomes: Retrospective: differences in requesting practice, result in different clinical scenarios, relative roles of procedure, clinical acumen in establishing diagnosis, usefulness of procedure. Prospective: change of requesting practice, impact on use.
Results: There were considerable differences in requesting practice. Non-specialists seem to use EEG as a diagnostic tool, especially in patients with "funny turns," when it is much more likely to yield potentially misleading than clinically useful information. The overall proportion of procedures considered to influence management, to be justifiable, and to be inappropriate were 16% (59), 28.3% (104), and 55.7% (205), respectively. In the prospective study the total number of requests was significantly reduced (²=33.85, df=5, P<0.0001), mainly because of fewer requests in patients with non-specific "funny turns" (²=21.90, df=6, P=0.0013). There was a concomitant change in the usefulness of EEG (² 26.99, df=2, P<0.0001).
Conclusions: This original audit informed clinical practice and had potential benefits for patients, clinicians, and provision of service. Systematic replication of this project, possibly on a regional basis, could result in financial savings, which would allow development of accessible local neurophysiology services.

What is already known on this topic There is unrestricted access to EEG in most district general hospitals throughout the United Kingdom The combination of equivocal symptoms and non-specific abnormalities carries a risk of misdiagnosis of epilepsy What this study adds An audit of requests for EEG showed that a large proportion were inappropriate, mainly because of the prevalent misconception that the procedure could prove or exclude a diagnosis of epilepsy in patients with "funny turns" After intervention with clinicians, which used an educative approach, there was a considerable and sustained change in requesting practice

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Rapid Responses:

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Is EEG access helpful?

Henry Smithson
bmj.com, 26 Apr 2001 [Full text]

Audit or Value Judgement?

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bmj.com, 27 Apr 2001 [Full text]

EEG as a diagnostic tool?

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