Home video review in a pediatric clinical neurophysiology led multidisciplinary team meeting

Assessment of the value of review of home videos by a pediatric multidisciplinary team (MDT) in a pediatric neurophysiology department.

We describe and evaluate the review of home videos alongside clinical history and previous investigations from patients referred to the Evelina pediatric EEG department at a twice-monthly MDT meeting between 01/2021 and 09/2022. We retrospectively analyzed measures of video quality, quantity and duration, time taken from referral to MDT meeting, pre-MDT and post-MDT meeting proposed diagnosis and clinical outcomes. Feedback from referring doctors was obtained by a survey.

There were 36 referrals for 34 patients totalling 123 videos. There was a median delay of 10 days between video upload and final report. After the MDT meeting the number of referrals classified as uncertain fell from 15 to 2. The number of referrals classified as non-epileptic events increased from seven to 18. The number classified as infantile spasms fell from six to two. Overall, 26 of 36 referrals had a change in diagnosis and 26 of 36 referrals were triaged away from the video-EEG telemetry (VT) waiting list. Nine out of ten referring doctors reported that MDT discussion improved their understanding of the events.

HVR is a useful tool that has been successfully incorporated into our neurophysiology department's workflow. These early results suggest benefits from adopting an MDT meeting may include an early diagnosis and management approach based upon consensus. Using HVR in a pediatric population may help triage urgent cases, conserve specialized neurophysiological investigations and streamline workflows to improve the efficiency of pediatric referrals.