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 characterize the seizure semiology and source of referral, in order to explore ways in which triaging of these referrals may be improved. 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 Hospital for Sick Children 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. 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.