Objective: To evaluate the diagnostic accuracy of 2 quantitative EEG display tools, color density spectral array (CDSA) and amplitude-integrated EEG (aEEG), for seizure identification in the intensive care unit (ICU). Methods:A set of 27 continuous EEG recordings performed in pediatric ICU patients was transformed into 8-channel CDSA and aEEG displays. Three neurophysiologists underwent 2 hours of training to identify seizures using these techniques. They were then individually presented with a series of CDSA and aEEG displays, blinded to the raw EEG, and asked to mark any events suspected to be seizures. Their performance was compared to seizures identified on the underlying conventional EEG. Results:The 27 EEG recordings contained 553 discrete seizures over 487 hours. The median sensitivity for seizure identification across all recordings was 83.3% using CDSA and 81.5% using aEEG. However, among individual recordings, the sensitivity ranged from 0% to 100%. Factors reducing the sensitivity included low-amplitude, short, and focal seizures. False-positive rates were generally very low, with misidentified seizures occurring once every 17-20 hours. Conclusions:Both CDSA and aEEG demonstrate acceptable sensitivity and false-positive rates for seizure identification among critically ill children. Accuracy of these tools would likely improve during clinical use, when findings can be correlated in real-time with the underlying raw EEG. In the hands of neurophysiologists, CDSA and aEEG displays represent useful screening tools for seizures during continuous EEG monitoring in the ICU. The suitability of these tools for bedside use by ICU nurses and physicians requires further study. Neurology Nonconvulsive seizures occur in 16%-48% of selected critically ill patients, and may contribute to brain injury if untreated.1-12 Detection of nonconvulsive seizures requires continuous EEG. Increasing awareness about nonconvulsive seizures has led to a growing demand for continuous EEG monitoring in ICUs. To facilitate interpretation of prolonged EEG recordings, several quantitative EEG display tools have been developed to highlight significant electrographic events and provide insight into EEG trends over time.Amplitude-integrated EEG (aEEG) depicts time-compressed and rectified EEG amplitude on a semi-logarithmic scale, and is now commonly employed to monitor cerebral function in neonates.13 While aEEG provides an accurate measure of neonatal EEG background, 14,15 its utility for seizure identification remains a matter of debate. 16 -18 To date, reports on the use of aEEG for seizure identification in pediatric and adult ICUs have been few and descriptive. 19 -22 Color density spectral array (CDSA) applies fast-Fourier transformation (FFT) to convert raw EEG into a time-compressed and color-coded display, also termed a color spectroe-Pub ahead of print on September 22, 2010, at www.neurology.org.

Day 3 somatosensory evoked potential grade related to information-processing speed, working memory, and the ability to attend to tasks 1 yr after traumatic brain injury. Day 3 somatosensory evoked potential grade had the strongest relationship with functional outcome. Somatosensory evoked potential grades were not related to emotional well-being.