Abstracts

At MCH, a select number of patients with medically intractable seizures undergo diagnostic admissions involving subtraction ictal SPECT co-registered to MRI (SISCOM). The timeliness and efficiency of radioisotope injection is crucial to the potential identification of epileptogenic foci. The optimum results yielded by this procedure requires timing of radioisotope injection to be as close to seizure onset as possible. However, little is known about factors that facilitate or hinder the efficiency of ictal injections. Our pilot study is an important first step in gathering objective data regarding facilitators and barriers to efficient radioisotope administration. A focus-group questionnaire was distributed to the Epilepsy Monitoring Unit (EMU) nursing staff in order to identify key factors related to injection response time. From this data, an item checklist was derived and subsequently used to evaluate a retrospective series of 16 consecutive radioisotope injections. Eight of these cases fell within 60 seconds of seizure onset. Eight injections occurred after the 60-second cutoff. Videotapes of each injection were independently reviewed by raters blind to response time. Results revealed timing efficiency was significantly related to a higher number of staff assisting in the procedure ([chi]²⁼11.20, p=.01). Although not statistically significant, a trend regarding an inverse relationship between gloving time and injection efficiency was evidenced. Other variables, including patient responsiveness, amount of environmental clutter, and the number of SISCOM patients on the unit were not related to time between seizure onset and injection. This pilot study is part of a broader investigation that includes prospective data derived from a larger group of study patients. Initial results identified a positive relationship between the number of staff available to assist in the procedure and the timing efficiency of SISCOM injections. These data may reflect several factors, including 1) efficacy of teamwork required to stabilize and prepare patients for injection and 2) increased consensus regarding the appropriateness of injection. The data also suggests gloving in advance, rather than at the time of seizure onset, facilitates speed of injection. Finally, these data may have important implications in the evaluation of acuity and staffing levels for patients undergoing ictal SPECT studies.