Abstracts

Rationale:
Video is a key diagnostic tool in paroxysmal disorders and the epilepsies. Clinical services lack secure systems to receive and archive video, instead, patients and carers bring videos to clinics or use unsecured means to share recordings. The Covid-19 pandemic accelerated development of the vCreateNeuro interactive, web-based, cloud storage platform which allows patients and carers to upload video and linked metadata which can be viewed and classified by clinicians from any device. Scottish Government funded a 6 month pilot of the service in 4 paediatric & adult neurology University Hospitals whilst 3 English centres had charitable Conclusion:
A secure patient to clinician video transfer service has had rapid patient and clinician engagement when integrated into clinical pathways. A significant number of outpatient attendances and investigations can be prevented and costly investigations saved. Events occurring daily are readily captured but far less frequent episodes can be recorded with rapid and correct diagnosis facilitated.
Funding. We report 7 weeks of data from paediatric neurology in Glasgow & Edinburgh, the first centres to pilot the service.
Method:
The platform runs on the Microsoft Azure Cloud utilising Transparent Data Encryption and Advanced Threat Protection. The application tier is protected by a Microsoft Web Application Firewall and Azure Monitor. Clinicians invite patients / carers to register and consent for the system using multi-factor authentication. Postcode links to the Scottish Index of Multiple Deprivation (SIMD). Registration is then approved by the service allowing the patient / carer to upload videos along with structured metadata linked to the video including triggers, frequency, responsiveness and post-event symptoms. The clinician views the event and records degree of certainty of diagnosis of epileptic or non-epileptic event ( > 50% or > 80% for each category). For events considered epileptic, seizure types are recorded and non-epileptic events are classified. After each video upload and clinical review the patient / carers and the clinician are asked to complete an online evaluation.
Results:
In the 7 weeks to 26 June 2020, 469 videos were uploaded relating to 127 patients (Table 1). SIMD ranking of patients reflects the general Scottish population indicating that the service is utilised equitably by all socio-economic groups. 52% of videos represented events occurring a few times a day however 27 (5.8%) were of events occurring once per month. 34% of videos were classified as epileptic (80% with a 80% certainty). The most frequent seizure types were epileptic spasms (20%), focal clonic (16%), and focal impaired awareness (16%). 66% of videos were classified as non-epileptic (81% with a > 80% certainty). The most frequent classifications were infantile gratification / stimulation (16%), stereotypes (12%) and sleep myoclonus (12%). On a 1-10 Likert scale 91% of carers ranked their overall experience of the system as 8 to 10 (80%). 46% felt the service prevented a trip to the hospital, with 51% unsure. Clinicians considered that in 48% of cases the video had presented an outpatient review or admission, prevented 8 MRI scans, 34 outpatient EEG and 20 inpatient video-EEG (Figure 2). Most videos took 5-10 minutes to review and respond to the family.
Funding:
:Scottish Government Technology Enabled Care Great Ormond Street Hospital Children’s Charity