Abstracts

Rationale: Continuous video EEG monitoring (vEEG) is noninvasive and can provide valuable information in the care of hospitalized pediatric patients. However, it is also costly and labor intensive, can be cumbersome to patients and families and may make other medical testing difficult to perform. There has been little study of its impact on clinical care in pediatric patients. Our study aims to identify characteristics of patients in whom clinical management is changed by video EEG monitoring results, in hopes to triage this resource to the appropriate groups. Methods: Records of all pediatric inpatients (PICU and floor) who were monitored with continuous vEEG during a two year period were retrospectively reviewed. Results: Ninety four studies were performed; 36 (38%) resulted in a change in clinical management. Of those ICU patients in whom management was changed, 89% (24/27) had clinical seizures prior to initiation of vEEG. Of those patients on the inpatient floor in whom management was changed, 89% (8/9) had prior history of epilepsy. The indication “Monitoring of Status Epilepticus” was the highest yield, with 75% (12/16) of studies resulting in a change in the patient’s treatment plan. The lowest yield indication was “Persistent Encephalolpathy/Screening for Non-convulsive Status Epilepticus”; of the 13 patients monitored for this indication without a history of epilepsy or prior seizure, only 1 record impacted clinical management, resulting in withdrawal of care.   Conclusions: Clinical seizures prior to monitoring and/or a history of epilepsy may predict change in clinical management after vEEG in encephalopathic pediatric patients.