Video Ambulatory EEG in Children: A Quality Improvement Study

Abstract

Purpose:We implemented a video ambulatory EEG (VA-EEG) Program as an alternative to inpatient video EEG monitoring for some patients given potential benefits related to quicker access, greater convenience, and lower cost. To evaluate the newly initiated program, we performed a quality improvement study to assess whether VA-EEG yielded studies with interpretable EEG and video quality that generated clinically beneficial data.Methods:This was a single-center prospective quality improvement study. We surveyed ordering clinicians, electroencephalographers, and caregivers regarding consecutive children who underwent clinically indicated VA-EEG. The primary outcome was the percentage of VA-EEG studies in which the ordering clinician reported that the study had answered the question of interest.Results:We evaluated 74 consecutive children selected to undergo clinically indicated VA-EEG by their clinicians and caregivers. Ordering clinicians reported that 77% of studies answered the question of interest. Electroencephalographers reported that the quality of the EEG and video was excellent or adequate in 100% and 92% of patients, respectively. Additionally, 84% of caregivers reported preferring VA-EEG if EEG data were needed in the future.Conclusions:Video ambulatory EEG may be an effective diagnostic modality among children selected by clinicians and caregivers to undergo long-term EEG monitoring. Given it is effective as well as convenient, accessible, and lower cost than inpatient EEG monitoring, all of which align with our institution's quality goals, we intend to expand our VA-EEG Program.

Proposed Pathway for the Utilization of Pediatric Ambulatory EEG

“…Neither longer EEG duration nor preselecting event frequency significantly improved A-EEG yield. Interestingly, three studies used video telemetry, 4–6 but their outcome was not significantly different from the other studies (events captured in 58% to 64%, answered the posed question in 59% to 77%). Including our findings, overall A-EEG was able to answer the posed question in 59% to 88% of patients (mean 71%, median 73%, SD 8.5).…”

“…Unfortunately, out of 43 reported events, 17 (39.5%) were poorly or not seen on video. 6 Indeed, one possible explanation for the similar successful rates obtained by A-EEG with and without video is that patients may move out of the camera's range during the suspicious events. [4][5][6]14 Over time, when A-EEG with synchronized video technology becomes widely available, we may have more robust data regarding its helpfulness in clinical practice.…”

“…According to our search criteria, 10 previous studies could be included for detailed review (Table 3). [1][2][3][4][5][6]8,[11][12][13] The number of children included ranged from 30 to 706 (mean 150.2, median 84, SD 192), and most studies recorded A-EEG for at least 24 hours. Half of the studies preselected patients for A-EEG using minimum reported frequency of clinical events.…”

“…Half of the studies preselected patients for A-EEG using minimum reported frequency of clinical events. [4][5][6]8,13 For those who required a minimum baseline frequency of suspected events, it ranged from at least daily events to 3 times per week. [1][2][3]11,12 The ability to successfully capture clinical events varied largely between studies, ranging from 46% to 89%.…”

“…4,5 Furthermore, A-EEG is widely accepted by families and their referring clinicians. 6 Compared with inpatient long-term video-EEG monitoring, A-EEG advantages include lower costs given there is no need for a hospital bed, and a more comfortable environment for children and families. 7 Technical issues affecting data interpretation from these home-recorded A-EEGs seem to account for the minority of unsuccessful studies.…”