Standardizing Infantile Spasms EEG Reports Using the BASED (Burden of AmplitudeS and Epileptiform Discharges) Score
Abstract number :
2.178
Submission category :
3. Neurophysiology / 3C. Other Clinical EEG
Year :
2025
Submission ID :
254
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: Amanda Weber, DO – Division of Neurology, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Shawn Aylward, MD – Nationwide Children's Hospital
Megan Rose, Quality Strategist – Nationwide Children's Hospital
Ahmed Awad, MD – Nationwide Children's Hospital
Corinne McCabe, MD – Nationwide Children's Hospital
Anup Patel, MD – Nationwide Children's Hospital
Warren Lo, MD – Nationwide Children's Hospital
Jaime Twanow, MD – Nationwide Children's Hospital
Christopher Beatty, MD, MAS – Division of Neurology, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Purva Choudhari, MD – Nationwide Children's Hospital
Megan Fredwall, MD – Nationwide Children's Hospital
Jorge Vidaurre, MD – Nationwide Children's Hospital and The Ohio State University
Neil Kulkarni, MD – Nationwide Children's Hospital
Dara Albert, DO – Nationwide Children's Hospital
Abdul Khuhro, MD – Nationwide Children's Hospital
John Mytinger, MD – Nationwide Children's Hospital
Rationale: Infantile epileptic spasms syndrome (IESS) is a developmental and epileptic encephalopathy that affects infants 1-24 months of age. Early diagnosis and electroclinical remission are associated with improved clinical outcomes. Historically, the resolution of hypsarrhythmia was thought to be necessary for electrographic remission. Hypsarrhythmia, however, is often absent on the pre-treatment EEG and has poor inter-rater reliability (IRR) In contrast, the is an interictal EEG assessment method used to score background features and define remission in children with IESS and has high IRR. With the goal of standardizing EEG reporting for children with IESS, we used quality improvement (QI) methodology to increase the percentage of EEG reports containing a BASED score, for infants up to 2 years with IESS at , from 52% to 80% and sustain for 1 year.
Methods: To establish a baseline BASED score utilization, we retrospectively analyzed EEG reports for children with IESS from quarter 1 of 2021 through quarter 2 of 2024. Using Quality Improvement (QI) methodology, educational and workflow-related interventions were implemented to evaluate and modify a standardized scoring template. Score accuracy was tracked as a balancing measure. Approximately 10% of EEGs were reviewed by an IS expert, who provided feedback to the original reader. Performance was analyzed quarterly after interventions and plotted on a p-chart, which was shared with interpreting physicians.
Results: From 2021 through July 2024, 303 IS EEG reports were reviewed to establish a baseline. 168 (2%) of the studies documented a BASED score. Since July 2024, 85% of studies have included a BASED score. 12/36 (33%) of IS EEGs have been reviewed since October 2024, and 2/12 (17%) of the BASED score assessments were different. The change in BASED score altered clinical management in 1 case (difference in score impacted assessment of remission and subsequent therapy).
Conclusions: The BASED score helps standardize EEG reporting and IS. This QI project sought to standardize EEG reporting in children with IESS by increasing the percentage of IS EEG reports that contained a BASED score assessment from at Nationwide Children’s Hospital. Educational and workflow-based interventions were introduced, which have increased the utilization of BASED score in our institution to 85%.
Funding: No funding was received in support of this work.
Neurophysiology