Inter-observer variability of the EEG diagnosis of seizures in comatose patients

Ronner, H.E.; Ponten, S.C.; Stam, Cornelis J.; Uitdehaag, Bernard M. J.

doi:10.1016/j.seizure.2008.10.010

Cited by 59 publications

(57 citation statements)

References 26 publications

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“…However, the optimal method for describing recurrent seizures has not been established and it remains unclear whether recurrent seizures have the same impact as a single prolonged seizure. Additionally, variability is reported among neurophysiologists detecting seizures 19,20 and rhythmic or periodic patterns 21 in critically ill patients. While EEG tracings in this study were interpreted by a single pediatric neurophysiologist to improve standardization, this may impact generalization of these data.…”

Section: Results Subject and Enrollment Characteristicsmentioning

confidence: 99%

Nonconvulsive seizures are common in critically ill children

Abend

Gutierrez‐Colina²,

Topjian³

et al. 2011

Neurology

195

256

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Section: Results Subject and Enrollment Characteristicsmentioning

confidence: 99%

Nonconvulsive seizures are common in critically ill children

Abend

Gutierrez‐Colina²,

Topjian³

et al. 2011

Neurology

195

256

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show abstract

“…A study of inter-observer agreement in seizure detection in critically ill adults demonstrated moderate agreement was demonstrated for seizure occurrence, but agreement was lower for more subtle seizure descriptors including their frequency, onset, and offset. (42) Similarly, identification of seizures has been shown to be very good among neonates with hypoxic-ischemic brain injury(43) and substantial among critically ill adults. (30)…”

Section: Discussionmentioning

confidence: 99%

Interrater Agreement of EEG Interpretation After Pediatric Cardiac Arrest Using Standardized Critical Care EEG Terminology

Abend¹,

Massey

Fitzgerald³

et al. 2017

Journal of Clinical Neurophysiology

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Purpose We evaluated interrater agreement of electroencephalography (EEG) interpretation in a cohort of critically ill children resuscitated after cardiac arrest using standardized EEG terminology. Methods Four pediatric electroencephalographers scored 10-minute EEG segments from 72 consecutive children obtained 24 hours after return of circulation using the American Clinical Neurophysiology Society’s (ACNS) Standardized Critical Care EEG terminology. The percent of perfect agreement and the kappa coefficient were calculated for each of the standardized EEG variables and a predetermined composite EEG background category. Results The Overall Background Category (normal, slow-disorganized, discontinuous, or attenuated-featureless) had almost perfect agreement (kappa 0.89). The ACNS Standardized Critical Care EEG variables had agreement that was (1) almost perfect for the seizures variable (kappa 0.93), (2) substantial for the continuity (kappa 0.79), voltage (kappa 0.70), and sleep transient (kappa 0.65) variables, (3) moderate for the rhythmic or periodic patterns (kappa 0.55) and inter-ictal epileptiform discharge (kappa 0.60) variables, and (4) fair for the predominant frequency (kappa 0.23) and symmetry (kappa 0.31) variables. Condensing variable options led to improved agreement for the continuity and voltage variables. Conclusions These data support the use of the standardized terminology and the composite Overall Background Category as a basis for standardized EEG interpretation for subsequent studies assessing EEG background for neuroprognostication after pediatric cardiac arrest.

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“…Furthermore, like interictal epileptiform discharges, although there are published criteria of EEG signal characteristics for recognizing electrographic seizures and PDs, it is not rare that inter-rater agreement (IRA) among EEG experts can be very poor, especially for cases with equivocal patterns or with more complex and abnormal background activities (Ronner et al, 2009). Since IRA reliability in recognizing these critical EEG events has significant implications for the value of EEG as a diagnostic tool, it is important to design studies that are similar to the clinical practice to assess IRA.…”

Section: Introductionmentioning

confidence: 99%

Inter-rater agreement on identification of electrographic seizures and periodic discharges in ICU EEG recordings

Halford

Shiau

Desrochers

et al. 2015

Clinical Neurophysiology

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Objective This study investigated inter-rater agreement (IRA) among EEG experts for the identification of electrographic seizures and periodic discharges (PDs) in continuous ICU EEG recordings. Methods Eight board-certified EEG experts independently identified seizures and PDs in thirty 1-hour EEG segments which were selected from ICU EEG recordings collected from three medical centers. IRA was compared between seizure and PD identifications, as well as among rater groups that have passed an ICU EEG Certification Test, developed by the Critical Care EEG Monitoring Research Consortium (CCEMRC). Results Both kappa and event-based IRA statistics showed higher mean values in identification of seizures compared to PDs (k = 0.58 vs. 0.38; p < 0.001). The group of rater pairs who had both passed the ICU EEG Certification Test had a significantly higher mean IRA in comparison to rater pairs in which neither had passed the test. Conclusions IRA among experts is significantly higher for identification of electrographic seizures compared to PDs. Additional instruction, such as the training module and certification test developed by the CCEMRC, could enhance this IRA. Significance This study demonstrates more disagreement in the labeling of PDs in comparison to seizures. This may be improved by education about standard EEG nomenclature.

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Inter-observer variability of the EEG diagnosis of seizures in comatose patients

Abstract: The EEG diagnosis of (non-convulsive) seizures in ICU patients is not very reliable, even when strict criteria such as proposed by Young are applied. There is a need for less ambiguous EEG criteria for (non-convulsive) seizures and status epilepticus.

Cited by 59 publications

References 26 publications

Nonconvulsive seizures are common in critically ill children

Nonconvulsive seizures are common in critically ill children

Interrater Agreement of EEG Interpretation After Pediatric Cardiac Arrest Using Standardized Critical Care EEG Terminology

Inter-rater agreement on identification of electrographic seizures and periodic discharges in ICU EEG recordings

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