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

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: Local data collection.

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: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

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 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.

What the quality statement means for patients, service users and carers

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