Predictors of recording an event during prolonged inpatient video electroencephalogram monitoring in children

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Abstract

Background Distinguishing between seizures and nonepileptic events is a key challenge in pediatric neurology. The diagnostic gold standard is prolonged inpatient video electroencephalogram monitoring. However, little is known about preadmission characteristics that are predictive of recording an event during such monitoring. Methods This is a retrospective chart review of children undergoing prolonged inpatient video electroencephalogram monitoring between 2009 and 2012 at a tertiary referral center for the purpose of distinguishing between seizures and nonepileptic events. Demographic information, medical history, event characteristics, and inpatient monitoring course were abstracted. Results Two-hundred thirteen children were identified. The median recording duration was 25 hours (interquartile range 22.4-48.5), and median time to event of interest (among those with an event recorded) was 4.5 hours (interquartile range 1.4-18.8). An event of interest was recorded in 66% of patients. At the event level, 20% of recorded events were associated with an electroencephalogram correlate, which refers to a change in the pattern seen on the electroencephalogram during a seizure. At the patient level, 112 (79.4%) with events recorded had only nonepileptic events recorded, 25 (17.7%) had only seizures recorded, and 4 (2.8%) had both recorded. Recording an event was predicted by the presence of intellectual disability (P = 0.001), greater preadmission event frequency (P <0.001), and shorter latency since most recent event (P <0.001). Conclusions Prolonged inpatient electroencephalogram monitoring captured an event of interest in two-thirds of patients, with most of these events captured within less than four and a half hours of recording onset. Several factors predict a greater yield with prolonged inpatient video electroencephalogram monitoring - including event frequency, latency since the most recent event, and the presence of intellectual disability - and can be used to counsel patients regarding this study for the purpose of event capture in the context of shared decision making.

Original languageEnglish (US)
Pages (from-to)458-463
Number of pages6
JournalPediatric Neurology
Volume50
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Inpatients
Electroencephalography
Seizures
Intellectual Disability
Neurology
Tertiary Care Centers
Decision Making
Demography
Pediatrics

Keywords

  • electroencephalogram
  • epilepsy
  • epilepsy monitoring unit
  • events
  • shared decision-making
  • spells
  • video encephalogram

ASJC Scopus subject areas

  • Clinical Neurology
  • Pediatrics, Perinatology, and Child Health
  • Developmental Neuroscience
  • Neurology
  • Medicine(all)

Cite this

@article{87dccb39a6424cb18d206deb555efaf8,
title = "Predictors of recording an event during prolonged inpatient video electroencephalogram monitoring in children",
abstract = "Background Distinguishing between seizures and nonepileptic events is a key challenge in pediatric neurology. The diagnostic gold standard is prolonged inpatient video electroencephalogram monitoring. However, little is known about preadmission characteristics that are predictive of recording an event during such monitoring. Methods This is a retrospective chart review of children undergoing prolonged inpatient video electroencephalogram monitoring between 2009 and 2012 at a tertiary referral center for the purpose of distinguishing between seizures and nonepileptic events. Demographic information, medical history, event characteristics, and inpatient monitoring course were abstracted. Results Two-hundred thirteen children were identified. The median recording duration was 25 hours (interquartile range 22.4-48.5), and median time to event of interest (among those with an event recorded) was 4.5 hours (interquartile range 1.4-18.8). An event of interest was recorded in 66{\%} of patients. At the event level, 20{\%} of recorded events were associated with an electroencephalogram correlate, which refers to a change in the pattern seen on the electroencephalogram during a seizure. At the patient level, 112 (79.4{\%}) with events recorded had only nonepileptic events recorded, 25 (17.7{\%}) had only seizures recorded, and 4 (2.8{\%}) had both recorded. Recording an event was predicted by the presence of intellectual disability (P = 0.001), greater preadmission event frequency (P <0.001), and shorter latency since most recent event (P <0.001). Conclusions Prolonged inpatient electroencephalogram monitoring captured an event of interest in two-thirds of patients, with most of these events captured within less than four and a half hours of recording onset. Several factors predict a greater yield with prolonged inpatient video electroencephalogram monitoring - including event frequency, latency since the most recent event, and the presence of intellectual disability - and can be used to counsel patients regarding this study for the purpose of event capture in the context of shared decision making.",
keywords = "electroencephalogram, epilepsy, epilepsy monitoring unit, events, shared decision-making, spells, video encephalogram",
author = "Wyatt, {Kirk D.} and Jayawant Mandrekar and Lily Wong-Kisiel and Nickels, {Katherine C} and Wirrell, {Elaine C}",
year = "2014",
doi = "10.1016/j.pediatrneurol.2014.01.038",
language = "English (US)",
volume = "50",
pages = "458--463",
journal = "Pediatric Neurology",
issn = "0887-8994",
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number = "5",

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T1 - Predictors of recording an event during prolonged inpatient video electroencephalogram monitoring in children

AU - Wyatt, Kirk D.

AU - Mandrekar, Jayawant

AU - Wong-Kisiel, Lily

AU - Nickels, Katherine C

AU - Wirrell, Elaine C

PY - 2014

Y1 - 2014

N2 - Background Distinguishing between seizures and nonepileptic events is a key challenge in pediatric neurology. The diagnostic gold standard is prolonged inpatient video electroencephalogram monitoring. However, little is known about preadmission characteristics that are predictive of recording an event during such monitoring. Methods This is a retrospective chart review of children undergoing prolonged inpatient video electroencephalogram monitoring between 2009 and 2012 at a tertiary referral center for the purpose of distinguishing between seizures and nonepileptic events. Demographic information, medical history, event characteristics, and inpatient monitoring course were abstracted. Results Two-hundred thirteen children were identified. The median recording duration was 25 hours (interquartile range 22.4-48.5), and median time to event of interest (among those with an event recorded) was 4.5 hours (interquartile range 1.4-18.8). An event of interest was recorded in 66% of patients. At the event level, 20% of recorded events were associated with an electroencephalogram correlate, which refers to a change in the pattern seen on the electroencephalogram during a seizure. At the patient level, 112 (79.4%) with events recorded had only nonepileptic events recorded, 25 (17.7%) had only seizures recorded, and 4 (2.8%) had both recorded. Recording an event was predicted by the presence of intellectual disability (P = 0.001), greater preadmission event frequency (P <0.001), and shorter latency since most recent event (P <0.001). Conclusions Prolonged inpatient electroencephalogram monitoring captured an event of interest in two-thirds of patients, with most of these events captured within less than four and a half hours of recording onset. Several factors predict a greater yield with prolonged inpatient video electroencephalogram monitoring - including event frequency, latency since the most recent event, and the presence of intellectual disability - and can be used to counsel patients regarding this study for the purpose of event capture in the context of shared decision making.

AB - Background Distinguishing between seizures and nonepileptic events is a key challenge in pediatric neurology. The diagnostic gold standard is prolonged inpatient video electroencephalogram monitoring. However, little is known about preadmission characteristics that are predictive of recording an event during such monitoring. Methods This is a retrospective chart review of children undergoing prolonged inpatient video electroencephalogram monitoring between 2009 and 2012 at a tertiary referral center for the purpose of distinguishing between seizures and nonepileptic events. Demographic information, medical history, event characteristics, and inpatient monitoring course were abstracted. Results Two-hundred thirteen children were identified. The median recording duration was 25 hours (interquartile range 22.4-48.5), and median time to event of interest (among those with an event recorded) was 4.5 hours (interquartile range 1.4-18.8). An event of interest was recorded in 66% of patients. At the event level, 20% of recorded events were associated with an electroencephalogram correlate, which refers to a change in the pattern seen on the electroencephalogram during a seizure. At the patient level, 112 (79.4%) with events recorded had only nonepileptic events recorded, 25 (17.7%) had only seizures recorded, and 4 (2.8%) had both recorded. Recording an event was predicted by the presence of intellectual disability (P = 0.001), greater preadmission event frequency (P <0.001), and shorter latency since most recent event (P <0.001). Conclusions Prolonged inpatient electroencephalogram monitoring captured an event of interest in two-thirds of patients, with most of these events captured within less than four and a half hours of recording onset. Several factors predict a greater yield with prolonged inpatient video electroencephalogram monitoring - including event frequency, latency since the most recent event, and the presence of intellectual disability - and can be used to counsel patients regarding this study for the purpose of event capture in the context of shared decision making.

KW - electroencephalogram

KW - epilepsy

KW - epilepsy monitoring unit

KW - events

KW - shared decision-making

KW - spells

KW - video encephalogram

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