title: Predictors of recording an event during prolonged inpatient video electroencephalogram monitoring in children.
abstract: BACKGROUND
  Distinguishing between seizures and nonepileptic events is a key challenge in pediatric neurology. The diagnostic gold standard is prolonged inpatient video electroencephalogram monitoring. However, little is known about preadmission characteristics that are predictive of recording an event during such monitoring.
  
  
  METHODS
  This is a retrospective chart review of children undergoing prolonged inpatient video electroencephalogram monitoring between 2009 and 2012 at a tertiary referral center for the purpose of distinguishing between seizures and nonepileptic events. Demographic information, medical history, event characteristics, and inpatient monitoring course were abstracted.
  
  
  RESULTS
  Two-hundred thirteen children were identified. The median recording duration was 25 hours (interquartile range 22.4-48.5), and median time to event of interest (among those with an event recorded) was 4.5 hours (interquartile range 1.4-18.8). An event of interest was recorded in 66% of patients. At the event level, 20% of recorded events were associated with an electroencephalogram correlate, which refers to a change in the pattern seen on the electroencephalogram during a seizure. At the patient level, 112 (79.4%) with events recorded had only nonepileptic events recorded, 25 (17.7%) had only seizures recorded, and 4 (2.8%) had both recorded. Recording an event was predicted by the presence of intellectual disability (P = 0.001), greater preadmission event frequency (P < 0.001), and shorter latency since most recent event (P < 0.001).
  
  
  CONCLUSIONS
  Prolonged inpatient electroencephalogram monitoring captured an event of interest in two-thirds of patients, with most of these events captured within less than four and a half hours of recording onset. Several factors predict a greater yield with prolonged inpatient video electroencephalogram monitoring--including event frequency, latency since the most recent event, and the presence of intellectual disability--and can be used to counsel patients regarding this study for the purpose of event capture in the context of shared decision making.
authors.affiliation: Mayo Medical School, Rochester, Minnesota.
authors.forename: Kirk D
authors.initials: KD
authors.lastname: Wyatt
authors.affiliation: Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jay
authors.initials: J
authors.lastname: Mandrekar
authors.affiliation: Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Lily
authors.initials: L
authors.lastname: Wong-Kisiel
authors.affiliation: Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Katherine
authors.initials: K
authors.lastname: Nickels
authors.affiliation: Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota. Electronic address: wirrell.elaine@mayo.edu.
authors.forename: Elaine
authors.initials: E
authors.lastname: Wirrell
mesh_terms: D000293:Adolescent; D001921:Brain / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007297:Inpatients; D008607:Intellectual Disability / Q000150:complications / Q000503:physiopathology; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors; D014741:Video Recording
keywords: electroencephalogram; epilepsy; epilepsy monitoring unit; events; shared decision-making; spells; video encephalogram