Abstracts

Rationale: The educational value of videos in medicine is well established, in particular in Pediatric Neurology where integrated multimedia has proven to be highly effective in educating both patients and medical staff. Given the widespread practice and potential repercussions of using YouTube as a source of information, available videos on YouTube portraying infantile epileptic spasms were reviewed for their efficacy as a proper educational tool by assessing their quality and diagnostic veracity using a novel rating system. Methods: The top 25 YouTube videos under each of the search terms infantile spasms , spasms, epileptic spasms and West syndrome were reviewed in November 2009. A Medical Video Rating System (MVRS) was devised and all videos were reviewed and scored by a staff neurologist (primary rater) using this scale to assess quality and diagnostic veracity. Videos were considered relevant only when displaying clinical examples of infantile epileptic spasms. In the first component of MVRS, technical quality of the relevant videos was scored by assessing lighting, sound, angle, resolution and duration out of a total score of 5. The videos displaying the proper diagnosis were then rated as being excellent (5/5), good (4/5), fair (3/5), poor (4/5) or very poor (1/5) clinical examples of infantile spasms in the second component of the rating system. Inter-rater variability of MVRS was assessed by having a second staff neurologist (secondary rater) rate the videos. McNemar s test was then used to determine whether the scores across the two raters were significantly different from each other. Results: Of the 100 videos obtained across all four search terms, 50% were deemed to be irrelevant by both raters. While the term infantile spasms yielded 75% of relevant videos, the term West syndrome yielded only 25% of relevant videos. Of all relevant videos, 60% obtained a perfect technical score, 54% had the proper diagnosis of infantile spasm and 29% were judged to be excellent clinical examples as assessed by the primary rater. The Medical Video Rating System possesses good inter-rater concordance with only a 10% disagreement between the primary and secondary raters for all examples. The scores were not considered to be statistically different using McNemar s test. Non-epileptic paroxysmal events wrongly labeled as infantile spasms included self gratification disorder, gastric reflux, dystonia and normal infant behavior. Conclusions: There are readily available examples of infantile spasms posted on YouTube. From a technical perspective, the majority of videos meets adequacy but content relevance varies depending on the search term utilized and only a minority of videos(10%)are excellent clinical examples with a potential for being used in medical education. The proposed rating tool known as MVRS possesses good inter-rater agreement and can be used to assess the reliability of videos as a teaching resource in infantile spasms. Such a tool can potentially be applied to evaluate video resources in other paroxysmal events and movement disorders.