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

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 but-ton 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 acti-vated by patients (41%), followed by nurses (31%) or family (17%). Twenty-nine percent of events repre-sented 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 electro-clinical 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 electroclin-ical 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 counter-measures should address narration challenges and improve inpatient seizure monitoring quality metrics. (c) 2022 Elsevier Inc. All rights reserved.