Abstract Details

IS is a seizure disorder in young children for which early diagnosis and treatment is critical. At the Hospital for Sick Children, rule-out IS accounts for a large percentage of outpatient EEG referrals, while few result in a diagnosis.

The goal of this study is to determine factors for predicting infantile spasm (IS) diagnoses and implement an EEG referral form to improve the triaging process for these urgent studies.

In the initial pilot study, a retrospective review was done on all 84 rule-out IS EEG referrals within a single year period (2018) at the Hospital for Sick Children to determine source of referral, description of episodes, and EEG result. Subsequently, a prospective parental survey study was performed on 40 patients referred between January-July 2020. Characteristics of the events and pertinent medical history were determined, and the relative risk and odds of these factors were calculated for positive IS diagnosis in order to create a referral form. In the ongoing stage, this referral form is being implemented for incoming orders to validate the scoring system. Community outreach to pediatricians for IS education is being developed.

Non-neurologists contributed the highest number of referrals, however 75% of these EEGs were normal. Factors that increased risk of positive IS diagnoses included developmental regression, antenatal risk factors, occurrence in clusters, presence of limb extension, and known syndrome or abnormal brain MRI. A sample referral form was created with associated scoring system which was accurate in predicting a positive diagnosis in these patients.

Improved triaging of EEG referrals may be achieved through increasing the details provided within referrals, screening referrals potentially using a scoring system, clarification of event semiology, and better IS education. This represents a critical opportunity for improvement of resource allocation as well as patient care and outcomes within all major referral centres.