Quality standard

Quality statement 4: Initial assessment – unnecessary use of electroencephalogram (EEG)

Quality statement 4: Initial assessment – unnecessary use of electroencephalogram (EEG)

Quality statement

People who have had a transient loss of consciousness are not routinely offered an electroencephalogram (EEG) to investigate the event.

Rationale

EEGs are usually carried out as part of initial investigations for epilepsy and are not routinely offered to investigate transient losses of consciousness. Great caution is needed in performing and interpreting an EEG if the clinical history offers limited or no support for a diagnosis of epilepsy. This is because a 'false positive' result may lead to misdiagnosis and inappropriate treatment. It is important that EEGs are not routinely requested inappropriately in the generalist setting as a diagnostic test to investigate unexplained transient loss of consciousness.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that people who have had a transient loss of consciousness are not routinely offered an EEG to investigate the event.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.

Process

Proportion of people who have had a transient loss of consciousness who have an EEG recorded to investigate the event.

Numerator – the number in the denominator who have an EEG recorded to investigate the event.

Denominator – the number of people who have had a transient loss of consciousness.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (acute, primary and secondary care) ensure that people who have had a transient loss of consciousness are not routinely offered an EEG to investigate the event.

Healthcare professionals ensure that they do not routinely offer an EEG to people who have had a transient loss of consciousness to investigate the event.

Commissioners (NHS England area teams, integrated care systems and clinical commissioning groups) ensure that they monitor and audit any routine EEG referrals to investigate a transient loss of consciousness event. They should also work with healthcare professionals to ensure that provider training and education is delivered to ensure that EEGs are not offered routinely to people who have had a transient loss of consciousness to investigate the event.

People who have had a blackout should not normally be offered an EEG (short for electroencephalogram) to investigate the cause of their blackout. This is a test that records the brain's electrical activity and is usually offered when epilepsy is suspected.

Source guidance

Transient loss of consciousness in over 16s. NICE guideline CG109 (2010, updated 2014), recommendations 1.1.2.4 and 1.2.2.1