Background

Infantile spasms (IS) is a seizure disorder in young children which can be challenging to recognize. Early diagnosis and treatment of IS is critical for prevention of developmental delay. At the Hospital for Sick Children, rule-out IS accounts a large percentage of outpatient EEG referrals, while few result in a diagnosis. The goal of this study was to develop a screening protocol based on characteristics of previous referrals, in order to improve triaging of these EEGs.

Methods

A retrospective review was done on all 84 rule-out IS EEG referrals within the last year at the Hospital for Sick Children. Source of referral, description of episodes, and result of EEG was extracted and data qualitatively analyzed.

Results

Neurologists at Sick Kids accounted for the least number of referrals however contributed the greatest percentage of IS diagnoses. Non-neurologists contributed the most referrals, however 75% of these EEGs were normal. Common semiologies as described by referring physicians are discussed in detail.

Conclusions

Improved triaging of EEG referrals may be achieved through screening of referrals by paediatric neurologists, 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. Based on the results of this study, a screening form for EEG referrals is proposed which may be implemented as a potential solution to more appropriately prioritize these referrals.