Inpatient long-term video-electroencephalographic monitoring event capture audiovisual diagnostic quality

Samuel Waller Terman, University of Michigan Department of Neurology, Ann Arbor, MI, USA. Electronic address: sterman@umich.edu.
Susanna S. O'Kula, State University of New York Downstate Health Sciences University Department of Neurology, Brooklyn, NY, USA; New York University Department of Neurology, New York City, NY, USA. Electronic address: susanna.okula@downstate.edu.
Melissa Marie Asmar, Emory University Department of Neurology, Atlanta, GA, USA; University of Pennsylvania Department of Neurology, Philadelphia, PA, USA. Electronic address: Melissa.Marie.Asmar@emory.edu.
Kathryn A. Davis, University of Pennsylvania Department of Neurology, Philadelphia, PA, USA. Electronic address: katedavis@pennmedicine.upenn.edu.
Deana M. Gazzola, New York University Department of Neurology, New York City, NY, USA. Electronic address: deanna.gazzola@nyulangone.org.
Rodica Lesanu, University of Michigan Department of Neurology, Ann Arbor, MI, USA. Electronic address: rionescu@med.umich.edu.
Laura George, University of Michigan Department of Neurology, Ann Arbor, MI, USA. Electronic address: lejo@med.umich.edu.
Linda M. Selwa, University of Michigan Department of Neurology, Ann Arbor, MI, USA. Electronic address: lmselwa@med.umich.edu.
Simon M. Glynn, University of Michigan Department of Neurology, Ann Arbor, MI, USA. Electronic address: simongly@med.umich.edu.
Chloe E. Hill, University of Michigan Department of Neurology, Ann Arbor, MI, USA. Electronic address: chloehi@med.umich.edu.

Document Type

Article

Abstract

OBJECTIVES: Long-term video-electroencephalographic monitoring (LTVEM) represents the gold-standard method to evaluate whether events represent electrographic seizures, but limited work has evaluated the quality of inpatient event capture. We evaluated the frequency of audiovisual factors impairing the ideal electroclinical correlation of seizure-like episodes during LTVEM. METHODS: We retrospectively reviewed consecutive inpatient LTVEM studies (11/2019-12/2019) from three academic epilepsy centers. We evaluated all pushbutton events for audiovisual characteristics such as whether the event was narrated, whether the patient was blocked on camera, and what diagnostic challenges impaired the electroencephalographer's ability to understand either the reason the event button was pushed or clinical semiology ("electroclinical correlation"). We determined the percent of events and studies with each outcome. RESULTS: There were 154 studies with 520 pushbutton events. The pushbutton was most commonly activated by patients (41%), followed by nurses (31%) or family (17%). Twenty-nine percent of events represented electrographic seizures, and 78% occurred in the Epilepsy Monitoring Unit. The reason for the push was not stated in 45% of events, and inadequate narration impaired electroclinical correlation in 19% of events. At least one relevant part of the patient's body was blocked during 12% of events, but this impaired electroclinical correlation in only 1% of events. There was at least one factor impairing electroclinical correlation in 21% of events, most commonly due to incomplete narration (N = 99), lights off (N = 15), or blankets covering the patient (N = 15). At least one factor impaired electroclinical correlation for any event in 36% of studies. CONCLUSION: Audiovisual factors impairing the electroencephalographer's ability to render an electroclinical correlation were common, particularly related to inadequate narration from bedside observers to explain the reason for pushing the button or event semiology. Future efforts to develop targeted countermeasures should address narration challenges and improve inpatient seizure monitoring quality metrics.

Medical Subject Headings

Humans; Electroencephalography (methods); Inpatients; Retrospective Studies; Seizures (diagnosis); Epilepsy (diagnosis); Monitoring, Physiologic

Publication Date

12-1-2022

Publication Title

Epilepsy & behavior : E&B

E-ISSN

1525-5069

Volume

137

Issue

Pt A

First Page

108947

PubMed ID

36274332

Digital Object Identifier (DOI)

10.1016/j.yebeh.2022.108947

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