Detection of Electrographic Seizures by Critical Care Providers Using Color Density Spectral Array After Cardiac Arrest Is Feasible*

Abstract

Objective To determine the accuracy and reliability of electroencephalographic seizure detection by critical care providers using color density spectral array (CDSA) electroencephalography (EEG). Participants Critical care providers (attending physicians, fellow trainees and nurses.) Interventions A standardized powerpoint CDSA tutorial followed by classification of 200 CDSA images as displaying seizures or not displaying seizures. Measurements and Main Results Using conventional EEG recordings obtained from patients who underwent EEG monitoring after cardiac arrest, we created 100 CDSA images, 30% of which displayed seizures. The gold standard for seizure category was electroencephalographer determination from the full montage conventional EEG. Participants did not have access to the conventional EEG tracings. After completing a standardized CDSA tutorial, images were presented to participants in duplicate and in random order. Twenty critical care physicians (12 attendings and 8 fellows) and 19 critical care nurses classified the CDSA images as having any seizure(s) or no seizures. The 39 critical care providers had a CDSA seizure detection sensitivity of 70% [95% CI: 67%, 73%], specificity of 68% [95% CI: 67%, 70%], positive predictive value of 46%, and negative predictive value of 86%. The sensitivity of CDSA detection of status epilepticus was 72% [95% CI: 69%, 74%]. Conclusion Determining which post-cardiac arrest patients experience electrographic seizures by critical care providers is feasible after a brief training. There is moderate sensitivity for seizure and status epilepticus detection and a high negative predictive value.

Seizure Detection by Critical Care Providers Using Amplitude-Integrated Electroencephalography and Color Density Spectral Array in Pediatric Cardiac Arrest Patients

“…Multiple two hour tracings could be made from the same patient. A pediatric electroencephalographer categorized these images as having no seizures, seizures or status epilepticus (15). Seizures were defined as abnormal paroxysmal events lasting more than 10 seconds or shorter if associated with a clinical change, with a temporal-spatial evolution in morphology, amplitude and frequency.…”

“…Methods for cEEG tracings acquisition and conversion to aEEG and CDSA tracings are described in our group’s previous published work (15). The CDSA tracings and corresponding aEEG tracings were the same as those used in our previous study (15).…”

“…To develop a program with bedside CCM clinician quantitative EEG (qEEG) interpretation, it is important to determine the optimal qEEG panels to present with the goal of seizure detection accuracy and CCM provider confidence. We previously determined the accuracy of compressed density spectral array (CDSA) interpreted by CCM providers for seizure detection as having a 70% sensitivity and 86% negative predictive value (NPV) after a brief 30 minute training session (15). Because amplitude-integrated EEG (aEEG) has been more extensively utilized with neonates and has reported seizure detection rates by electroencephalographers and neonatologists of 22–80%, we aimed to compare seizure detection rates of CCM providers using aEEG and the combination of aEEG and CDSA (aEEG+CDSA) to gold standard of electroencephalographer interpretation of full montage EEG in children following cardiac arrest(16–23).…”

“…CDSA uses Fourier transformation to present EEG power (amplitude 2 /Hz) (color) and frequency (y-axis) over time (x-axis). They both have the advantage of displaying several hours of compressed EEG data as a single image (15, 19, 24)(Figure 1). …”

Seizure Detection in the PICU

“…In this issue Topjian and colleagues (5) investigated the sensitivity and reliability of color density spectral array (CDSA), a quantitative EEG modality, in detecting electrographic seizures by the pediatric critical care providers. They demonstrated that the pediatric critical care providers with varying experience level could retrospectively identify electrographic seizures based on cEEG-derived CDSA images with reasonable accuracy and reliability following brief training.…”