Abstracts

Rationale: Inpatient long-term video electroencephalogram (EEG) monitoring is the traditional gold standard for obtaining electroencephalographic data in patients. However, this modality is labor intensive, costly, and presents additional challenges for pediatric patients due to change in environment, risk of hospital-acquired infection, and caregiver inconvenience. Video ambulatory EEG (VA-EEG) offers an alternative modality for some patients. We aimed to determine if VA-EEG was useful in children. Methods: We performed an interim analysis of a prospective single-center observational quality improvement project at a quaternary pediatric hospital with a comprehensive epilepsy program. Consecutive children were referred for VA-EEG at the discretion of the ordering provider. Electroencephalographers, ordering providers, caregivers, and EEG staff were surveyed regarding their experiences at the conclusion of the VA-EEG. Data were acquired using REDCap. Analysis used descriptive statistics. Categorical and binary variables are presented as frequencies and percentages. Continuous variables are presented as means (standard deviation) or medians (interquartile range). Results: Sixty-six subjects were included for this interim analysis. The median patient age was 9.5 years (IQR 6, 14). VA-EEG was ordered for differential diagnosis for 53 patients (80%), assessment of interictal activity for 21 patients (32%), seizure classification for 10 patients (15%), evaluation for electrical status epilepticus of sleep for 5 patients (7%), and assessment of seizure burden in 1 patient (2%) (multiple indications permitted). Among caregivers, 64 (97%) reported no problems using VA-EEG equipment, 49 (74%) reported that VA-EEG answered the clinical question of interest, and 55 (83%) reported that they would prefer VA-EEG use over inpatient EEG monitoring in the future. Office staff completed 52 surveys (79% of total cohort) and reported no difficulty obtaining insurance approval for VA-EEG. Among ordering providers, 51 (77%) responded that VA-EEG answered the intended clinical question while the event of interest did not occur in 13 cases (20%) and technical difficulty with video equipment occurred in 2 cases (3%). Among electroencephalographers, the quality of EEG was reported as excellent in 74%, adequate in 26%, and inadequate in 0% of records. Further, the quality of the video was reported as excellent in 73%, adequate in 20%, and inadequate in 8% of records. VA-EEG assuaged the need for LTM in 97% of cases. All ordering providers (100%) stated that they would order VA-EEG again. Conclusions: AV-EEG is well tolerated and may serve as an alternative modality to inpatient EEG monitoring for a subset of pediatric patients, thereby potentially reducing costs and risks associated with hospitalizations. Funding: No funding