Table 2.

PICO-Based Inclusion/Exclusion Criteria for Literature Screening

Participants	Among patients with:  • Epilepsy (controlled or uncontrolled)  • Recurrent seizure-like events  • Suspected epilepsy based on multiple episodes Receiving treatment at epilepsy centers including a focus on:  • Inpatient (EMU, exclude ICU monitoring for complex neurologic conditions other than epilepsy)  • Outpatient (office-based clinic care, telehealth)  • Accreditation level  • Patient characteristic (adult, pediatric, mixed)  • Geographic setting (rural medically underserved, urban medically underserved, suburban, rural not medically underserved, urban not medically underserved) Subgroups of interest: age 65+, pediatric patients, women, rare epilepsy syndromes/conditions
Interventions	Services including but not limited to:  • Electrodiagnostic (e.g., 24-h video-EEG with either surface electrodes or sphenoidal electrodes, intracarotid amobarbital (Wada) testing, functional cortical mapping, evoked potential recording capable of being safely used with intracranial electrodes, electrode localization)  • Neurosurgery (e.g., emergency or elective including biopsy and removal of incidental lesions, treatment of cerebral complications of epileptic seizures, stereotactic techniques, management of surgical complications, corpus callosotomy)  • Imaging (e.g., computerized axial tomography, cerebral angiography, interictal positron emission tomography, fMRI)  • Pharmacologic expertise (e.g., quality-assured anticonvulsant serum drug levels)  • Neuropsychological (e.g., comprehensive test batteries for cerebral dysfunction)  • Psychosocial services (e.g., inpatient and outpatient psychological services for assessment and treatment of chronic epilepsy)  • Rehabilitation (e.g., physical, occupational, speech therapy)  • Access to higher level care (e.g., ICU, anesthesia, emergency resuscitative equipment)  • Care coordination (e.g., medication authorizations, home medical equipment, transition from inpatient to outpatient)  • Genetic testing and counseling  • Patient and caregiver education  • Dietary management  • Services for special populations (e.g., language interpretation services, rare epilepsies) Essential elements of the inpatient EMU including but not limited to:  • The design and layout of the physical space to provide access, observation and monitoring needs of patients, and safety considerations  • The equipment needed to perform services  • Data collection protocols and management  • Additional facility protocols (e.g., transportation, fall prevention, medication reduction, standard order set) Personnel including but not limited to:  • Epilepsy specialists  • Providers associated with neurosurgery  • Providers associated with diagnostic testing  • Psychosocial and care coordinators  • Nursing  • Advance practice providers
Comparators	Not applicable (include all)
Outcomes and outcome measures	Any center outcomes including but not limited to:  Center-wide clinical outcomes determined from data sets  Reduced hospitalizations, morbidity, or mortality (over a period of time) Nonclinical outcomes including but not limited to:  Patient volumes  Financial outcomes  Staff turnover rates  Number of times the center was sued  Patient complaints  Patients signing out or leaving prematurely due to dissatisfaction with care or requesting a new source of care  Patient satisfaction  Press Gainey scores, wait times for appointments, in-clinic wait, return of phone calls Patient outcomes including but not limited to:  Seizure frequency  Seizure freedom  Emergency department visits  Hospital readmission  Quality of life  Functional status  Behavioral health  Mortality  Education/employment status
Timing	Any
Study designs	Keep:  • RCT (phase 1–4)  • Non-RCTs (phase 1–4)  • Observational, noncomparative  • Observational studies, comparative  • Cross-sectional  • Prospective cohort  • Retrospective cohort  • Nonconcurrent cohort  • Systematic reviews/meta-analyses  • Pooled analyses  • Case-control Reject (wrong study design):  • Case reports/series  • Prognostic course/factor studies  • Modeling studies  • Preclinical  • Narrative reviews Reject (other reason for rejection):  • In vitro  • Not a clinical study  • Not a treatment study  • Animal studies  • Non-English  • Duplicate publication
Notes	Despite a long intervention list, any intervention/institution characteristic is acceptable Despite a long outcome list, any outcome reported is acceptable Hierarchy is to reject all nonepilepsy studies for wrong population > reject studies with no new data for not a clinical study > reject studies with no center information for wrong intervention

Abbreviations: ICU = intensive care unit; EMU = epilepsy monitoring unit; PICO = Populations/Interventions/Comparators/Outcomes; RCT = randomized clinical trial.