Utilization of Long-term Video EEG Monitoring in Pediatric Patients: Experience of a Large Pediatric Tertiary Care Center
Abstract number :
2.006
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2022
Submission ID :
2204771
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Jenny Lin, MD – Children's Hospital of Atlanta/Emory University; Avni Sanghi, MD – Children's Healthcare of Atlanta / Emory University; Bryan Philbrook, MD – Children's Healthcare of Atlanta / Emory University; Sonam Bhalla, MD – Children's Healthcare of Atlanta / Emory University; Ruba Al-Ramadhani, MD – Children's Healthcare of Atlanta / Emory University
Rationale: Long-term video EEG monitoring (LTVM) is a vital noninvasive neuromonitoring tool that aids in recording epileptiform abnormalities and seizures. In the inpatient setting, it ultimately aids in the identification of nonconvulsive subclinical seizures and status epilepticus, which has been reported to occur in 25% in one pediatric critical care cohort. To maintain LTVM continuously in a large clinical hospital, it requires extensive resources, personnel, and clinicians. Ongoing struggle occurs on institutional levels of how to balance limited resources and staff with the demand of patient care. _x000D_
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Children’s Healthcare of Atlanta consists of two large pediatric tertiary care centers with a total of 568 inpatient beds. The aim of this study is to retrospectively describe our experience of inpatient clinical utilization of LTVM. _x000D_
Methods: Retrospective review was conducted over a 2-month period from August 1 through September 30, 2021. Inclusion criteria included LTVM studies of pediatric patients aged 0 to 21 years. LTVM studies were identified from the Nihon Kohden database. Exclusion criteria were EEG’s done in outpatient or in the Epilepsy Monitoring Unit. Demographic, clinical, and EEG seizure data were reviewed. The authors plan to continue to collect more patients for this study.
Results: There were 276 LTVM studies and 9,192 hours 44 minutes of cumulative EEG data over the two-month period. The mean LTVM’s started per day were 4.5 studies (0 to 9). The mean daily total LTVM EEG data was 150 hours 42 minutes. The median age of patients was 5.2 years (0 days to 20.7 years) with 33% (n=92) children 1-10 years, 30% (n=82) infants, 24% (n=66) over 10 years, and 13% (n=36) neonates (Figure 1). There were 47% (n=130) female and 53% (n=146) male patients. The median duration of a study was 33 hours 18 minutes (1 hour 55 minutes to 205 hours 34 minutes). Most common indications included seizure-like activity (53%, n=145), AMS (9%, n=26), status epilepticus (8%, n=23), and breakthrough seizures (8%, n=21). Seizures were recorded on EEG in 26% (n=72). 47% of seizures (n=33) were electrographic, 40% (n=28) clinical, 10% (n=7) both, and 3% (n=2) on the ictal-interictal continuum. In a subanalysis of patients with multiple electrographic seizures only, 10/19 (52%) patients had seizures within 1 hour of LTVM initiation, 18/19 (94%) within 24 hours, and 19/19 (100%) within 72 hours.
Conclusions: LTVM utilization in the inpatient setting is rapidly increasing. Children and infants were most frequently evaluated by LTVM. Most common indications for LTVM were seizure-like activity, AMS, and status epilepticus. Seizures were recorded in 72 patients (26%), of which 28 (40%) were electroclinical. Of electrographic seizures, 94% were detected within 24 hours.
Funding: None
Neurophysiology