Diagnostic Accuracy of Electrographic Seizure Detection by Neurophysiologists and Non-Neurophysiologists in the Adult ICU Using a Panel of Quantitative EEG Trends

Abstract

Purpose: To evaluate the sensitivity and specificity of a panel of quantitative EEG (qEEG) trends for seizure detection in adult intensive care unit (ICU) patients when reviewed by neurophysiologists and non-neurophysiologists. Methods: One hour qEEG panels (n ¼ 180) were collected retrospectively from 45 ICU patients and were distributed to 5 neurophysiologists, 7 EEG technologists, and 5 Neuroscience ICU nurses for evaluation of seizures. Each panel consisted of the following qEEG tools, displayed separately for left and right hemisphere electrodes: rhythmicity spectrogram (rhythmic run detection and display; Persyst Inc), color density spectral array, EEG asymmetry index, and amplitude integrated EEG. The reviewers did not have access to the raw EEG data. Results: For the reviewer's ability to detect the presence of seizures on qEEG panels when compared with the gold standard of independent raw EEG review, the sensitivities and specificities are as follows: neurophysiologists 0.87 and 0.61, EEG technologists 0.80 and 0.80, and Neuroscience ICU nurses 0.87 and 0.61, respectively. There was no statistical difference among the three groups regarding sensitivity. Conclusions: Quantitative EEG display panels are a promising tool to aid detection of seizures by non-neurophysiologists as well as by neurophysiologists. However, even when used as a panel, qEEG trends do not appear to be adequate as the sole method for reviewing continuous EEG data.

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

“…Prior studies have reported similar sensitivity rates using aEEG or CDSA (15,16,32–35). However, the majority of these studies evaluated the ability of neurophysiologists or neurologists to detect seizures as opposed to that of non EEG trained bedside providers.…”

“…However, the majority of these studies evaluated the ability of neurophysiologists or neurologists to detect seizures as opposed to that of non EEG trained bedside providers. One study that included 5 neuroscience nurses who received a 15 minute training tutorial had a sensitivity for seizure detection on CDSA and aEEG of 87%, but with a specificity of 61.6%(35). Furthermore, a study including 2 neurointensive care nurses who underwent a 5–6 hour training had a sensitivity of 92–99% and specificity of 89–90% for seizure detection on aEEG and CDSA used together (36).…”

“…(32,33,35) A 30 minute tutorial seems insufficient and a future direction will be to evaluate whether more intensive training can improve seizure detection rates. aEEG and CDSA are potential seizure detection tools that may help CCM providers detect some seizures they would otherwise have been unaware of because of lack of cEEG accessibility.…”

Performance of Spectrogram-Based Seizure Identification of Adult EEGs by Critical Care Nurses and Neurophysiologists

“…Compressed spectral arrays (CSA) are a common way to visualize EEG trends and have been used in most prior studies of the use of qEEG for seizure detection in adults (Moura et al , 2014; Williamson et al , 2014; Dericioglu et al , 2015; Swisher et al , 2015; Topjian et al , 2015). CSA is produced by applying spectral estimation techniques to continuous EEG data, thereby producing a three-dimensional compressed spectrogram with time on the x-axis, frequency on the y-axis, and EEG power on the z-axis (Bickford et al , 1972; Bricolo et al , 1978).…”

“…A handful of studies have also evaluated the sensitivity of CSA alone for detecting seizures by physicians and ICU nurses (Stewart et al , 2010; Pensirikul et al , 2013; Dericioglu et al , 2015; Swisher et al , 2015; Topjian et al , 2015). Of all members of the care team, ICU nurses have the most frequent patient interaction and are typically charged with alerting physicians to changes in vital signs, neurological status, cardiac telemetry and other monitored systems.…”