{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:40:59Z","timestamp":1787319659507,"version":"build-2736575974"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T00:00:00Z","timestamp":1754438400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of the Child Neurology Society"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Longer duration of epilepsy before surgery is a predictor of poor outcome. While referral delays of surgical candidates are well documented, factors causing delay during the presurgical evaluation remain unclear and may vary depending on institutional characteristics. By benchmarking the duration of presurgical evaluation across multiple centers and identifying patient and evaluation characteristics contributing to duration, we can ascertain best practices and address modifiable contributors to reduce delays.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We queried the Pediatric Epilepsy Research Consortium Surgery Database, a prospective, observational multicenter study enrolling children 0\u201318 years at 27 US pediatric epilepsy centers, for all patients undergoing initial presurgical evaluation for drug\u2010resistant epilepsy (DRE). We included patients with completed evaluations and data on duration from initiation of presurgical evaluation to final surgical decision. We compared patient characteristics and evaluation components between those with long duration evaluations (&gt;\u200975% quartile) and those with short evaluations (&lt;\u200925% quartile). Akaike information criteria selection identified variables associated with longer duration. From these, we developed a logistic prediction model for evaluation duration, using a random 80\/20 training\/testing split of the entire cohort. The model was tested among institutions with\u2009\u2265\u200910 patients in the cohort to assess its accuracy in predicting long durations. Linear models for each site assessed each variable's impact on duration. Variables with &lt;\u200910% of the patient population at each site were excluded. Beta values were compared to identify intra\u2010 and inter\u2010institution variability and to delineate institutions with the shortest added duration for each variable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 2318 patients undergoing surgical evaluation, 1655 (71%) from 23 sites had complete data. Median evaluation duration was 8 weeks (interquartile range 3\u201322); 453 (27%) were short\u2010duration evaluations and 414 (25%) were long\u2010duration evaluations. Multiple patient and evaluation characteristics were associated with duration (Table 1). Table 6 provides the average duration each variable contributes to evaluation by site, highlighting the shortest durations compared with other groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Duration of presurgical evaluation for DRE can be accurately modeled using multiple patient characteristics and testing strategies commonly employed in epilepsy surgery evaluations. This predictive model can not only estimate evaluation duration but also identify opportunities to improve systemic efficiency. Institution\u2010level modeling identifies specific program strengths, providing an opportunity to learn from successful processes. Subsequent research will focus on institutional process mapping to better understand systemic practices that lead to improved efficiencies, then sharing these processes across the consortium to shorten evaluation durations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns3.70027","type":"journal-article","created":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T13:08:41Z","timestamp":1754485721000},"page":"188-200","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Factors Influencing the Duration From the Initiation of Surgical Evaluation to Final Intervention in Pediatric Epilepsy Surgery"],"prefix":"10.1002","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7799-9268","authenticated-orcid":false,"given":"Ruba","family":"Al\u2010Ramadhani","sequence":"first","affiliation":[{"name":"Division of Child Neurology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2971-7131","authenticated-orcid":false,"given":"Ann","family":"Hyslop","sequence":"additional","affiliation":[{"name":"Department of Neurology and Neurological Sciences Stanford University Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery R.","family":"Caraway","sequence":"additional","affiliation":[{"name":"Jane and John Justin Institute for Mind Health Cook Children's Medical Center Fort Worth Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J.","family":"Novotny","sequence":"additional","affiliation":[{"name":"Norcliffe Foundation Center for Integrative Brain Research Seattle Children's Hospital Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam P.","family":"Ostendorf","sequence":"additional","affiliation":[{"name":"Department of Child Neurology Nationwide Children's Hospital Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista L.","family":"Eschbach","sequence":"additional","affiliation":[{"name":"The Neuroscience Institute Children's Hospital Colorado Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allyson L.","family":"Alexander","sequence":"additional","affiliation":[{"name":"The Neuroscience Institute Children's Hospital Colorado Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lily C.","family":"Wong\u2010Kisiel","sequence":"additional","affiliation":[{"name":"Division of Epilepsy, Department of Neurology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dewi F.","family":"Depositario\u2010Cabacar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Children's National Hospital George Washington University Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chima O.","family":"Oluigbo","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurosurgery, Children's National Hospital George Washington University Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cemal","family":"Karakas","sequence":"additional","affiliation":[{"name":"Norton Children's Neuroscience Institute University of Louisville Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir R.","family":"Karia","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Louisville Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyamvada","family":"Tatachar","sequence":"additional","affiliation":[{"name":"Neurology and Epilepsy Center, Ann &amp; Robert H. Lurie Children's Hospital of Chicago Northwestern University Feinberg School of Medicine Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Bolton","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Children's Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar D.","family":"Pichon","sequence":"additional","affiliation":[{"name":"Department of Child Neurology Children's Hospital Orange County Orange California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel W.","family":"Shrey","sequence":"additional","affiliation":[{"name":"Department of Child Neurology Children's Hospital Orange County Orange California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin Fedak","family":"Romanowski","sequence":"additional","affiliation":[{"name":"Department of Child Neurology, CS Mott Children's Hospital University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy A.","family":"McNamara","sequence":"additional","affiliation":[{"name":"Department of Child Neurology, CS Mott Children's Hospital University of Michigan Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6723-9775","authenticated-orcid":false,"given":"Ernesto","family":"Gonzalez\u2010Giraldo","sequence":"additional","affiliation":[{"name":"Weill Institute for Neurosciences University of California San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurtis","family":"Auguste","sequence":"additional","affiliation":[{"name":"Weill Institute for Neurosciences University of California San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danilo","family":"Bernardo","sequence":"additional","affiliation":[{"name":"Weill Institute for Neurosciences University of California San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rani K.","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Child Neurology Atrium Health; Wake Forest University School of Medicine Charlotte North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradeep K.","family":"Javarayee","sequence":"additional","affiliation":[{"name":"Department of Neurology Medical College of Wisconsin Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny J.","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurology Children's Healthcare of Atlanta Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason C.","family":"Coryell","sequence":"additional","affiliation":[{"name":"Division of Neurology, Doernbecher Children's Hospital Oregon Health &amp; Sciences University 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