Electroencephalograph with Remote Interpretation for Emergency Care: A Prospective Clinical Trial

Abstract Accurate and timely diagnosis of impaired consciousness in emergencies is critical, particularly for patients with non-convulsive status epilepticus (NCSE), which poses a diagnostic challenge due to the absence of visible convulsive seizures, risking delayed treatment or incorrect intervention in case of misdiagnosis. This study evaluates a novel remote electroencephalogram (EEG) interpretation system combining a headset-type EEG with a digital communication application (Join) to enhance diagnostic speed and accuracy. In this prospective single-arm study, patients with consciousness disturbances requiring EEGs were assessed by both on-site epileptologists and remote interpreters. Diagnostic concordance was measured using Cohen's κ, and time to diagnosis was compared using the Mann–Whitney U test. Results showed 92.5% agreement between conventional and remote EEG (κ = 0.889, p = 0.01). Among 20 enrolled patients, the remote system achieved a significantly faster median diagnosis time (7 vs 27 min; p = 0.0000013), while accurately identifying NCSE and epileptic discharges. Notably, the remote approach detected more non-epileptic causes than on-site assessments. The headset-EEG and remote interpretation system combination demonstrated high diagnostic efficiency and accuracy in a Japanese emergency setting, with potential to improve outcomes through rapid diagnosis. Future research should include multi-center trials and explore integrating video-sharing features for enhanced clinical evaluation.