Electroencephalographic reactivity testing in unconscious patients: a systematic review of methods and definitions

Admiraal, Marjolein M.; Rootselaar, A.F. van; Horn, Janneke

doi:10.1111/ene.13219

Cited by 47 publications

(33 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The presence of reactivity seems very sensitive for prediction of a good outcome, but lacks specificity to make relevant predictions of outcome . Results on absent reactivity for the prediction of poor outcome are conflicting, most likely resulting from a lack of standardization of stimulus protocols and quantitative definitions of reactivity . Studies on the additional value of reactivity over background EEG pattern for prediction of outcome after cardiac arrest are lacking.…”

Section: Discussionsupporting

confidence: 87%

Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study

Ruijter

Tjepkema-Cloostermans

Tromp

et al. 2019

Annals of Neurology

143

141

View full text Add to dashboard Cite

Objective To provide evidence that early electroencephalography (EEG) allows for reliable prediction of poor or good outcome after cardiac arrest. Methods In a 5‐center prospective cohort study, we included consecutive, comatose survivors of cardiac arrest. Continuous EEG recordings were started as soon as possible and continued up to 5 days. Five‐minute EEG epochs were assessed by 2 reviewers, independently, at 8 predefined time points from 6 hours to 5 days after cardiac arrest, blinded for patients’ actual condition, treatment, and outcome. EEG patterns were categorized as generalized suppression (<10 μV), synchronous patterns with ≥50% suppression, continuous, or other. Outcome at 6 months was categorized as good (Cerebral Performance Category [CPC] = 1–2) or poor (CPC = 3–5). Results We included 850 patients, of whom 46% had a good outcome. Generalized suppression and synchronous patterns with ≥50% suppression predicted poor outcome without false positives at ≥6 hours after cardiac arrest. Their summed sensitivity was 0.47 (95% confidence interval [CI] = 0.42–0.51) at 12 hours and 0.30 (95% CI = 0.26–0.33) at 24 hours after cardiac arrest, with specificity of 1.00 (95% CI = 0.99–1.00) at both time points. At 36 hours or later, sensitivity for poor outcome was ≤0.22. Continuous EEG patterns at 12 hours predicted good outcome, with sensitivity of 0.50 (95% CI = 0.46–0.55) and specificity of 0.91 (95% CI = 0.88–0.93); at 24 hours or later, specificity for the prediction of good outcome was <0.90. Interpretation EEG allows for reliable prediction of poor outcome after cardiac arrest, with maximum sensitivity in the first 24 hours. Continuous EEG patterns at 12 hours after cardiac arrest are associated with good recovery. ANN NEUROL 2019;86:203–214

show abstract

Section: Discussionsupporting

confidence: 87%

Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study

Ruijter

Tjepkema-Cloostermans

Tromp

et al. 2019

Annals of Neurology

143

141

View full text Add to dashboard Cite

show abstract

“…6,15,31 In this study, stimulations were always executed in the same order, with increasing intensity of stimulation, and the full stimulus protocol was always executed. 6,15,31 In this study, stimulations were always executed in the same order, with increasing intensity of stimulation, and the full stimulus protocol was always executed.…”

Section: Discussionmentioning

confidence: 99%

“…Stimulation protocols between studies vary widely, and guidelines do not state which stimuli to use. 6,15,31 In this study, stimulations were always executed in the same order, with increasing intensity of stimulation, and the full stimulus protocol was always executed. Only clinical arousal was a reason to discontinue the protocol.…”

Section: Discussionmentioning

confidence: 99%

“…[6][7][8]10 Absence of EEG-R has been reported with a specificity ranging between 70 and 100% for prediction of poor outcome. 15 The studies performed so far have been mainly single-center studies with limited cohort sizes. 7,8 Unfortunately, protocols for EEG-R are often poorly described and vary widely, and a clear definition for interpretation of EEG-R is not available.…”

mentioning

confidence: 99%

“…7,8 Unfortunately, protocols for EEG-R are often poorly described and vary widely, and a clear definition for interpretation of EEG-R is not available. 15 The studies performed so far have been mainly single-center studies with limited cohort sizes. Nevertheless, EEG-R in combination with other factors is included in recommendations for neurological prognostication in comatose patients after CA.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Admiraal

Rootselaar

Hofmeijer

et al. 2019

Annals of Neurology

View full text Add to dashboard Cite

Objective Outcome prediction in patients after cardiac arrest (CA) is challenging. Electroencephalographic reactivity (EEG‐R) might be a reliable predictor. We aimed to determine the prognostic value of EEG‐R using a standardized assessment. Methods In a prospective cohort study, a strictly defined EEG‐R assessment protocol was executed twice per day in adult patients after CA. EEG‐R was classified as present or absent by 3 EEG readers, blinded to patient characteristics. Uncertain reactivity was classified as present. Primary outcome was best Cerebral Performance Category score (CPC) in 6 months after CA, dichotomized as good (CPC = 1–2) or poor (CPC = 3–5). EEG‐R was considered reliable for predicting poor outcome if specificity was ≥95%. For good outcome prediction, a specificity of ≥80% was used. Added value of EEG‐R was the increase in specificity when combined with EEG background, neurological examination, and somatosensory evoked potentials (SSEPs). Results Of 160 patients enrolled, 149 were available for analyses. Absence of EEG‐R for poor outcome prediction had a specificity of 82% and a sensitivity of 73%. For good outcome prediction, specificity was 73% and sensitivity 82%. Specificity for poor outcome prediction increased from 98% to 99% when EEG‐R was added to a multimodal model. For good outcome prediction, specificity increased from 70% to 89%. Interpretation EEG‐R testing in itself is not sufficiently reliable for outcome prediction in patients after CA. For poor outcome prediction, it has no substantial added value to EEG background, neurological examination, and SSEPs. For prediction of good outcome, EEG‐R seems to have added value. ANN NEUROL 2019

show abstract

Unveiling variability: A systematic review of reproducibility in visual EEG analysis, with focus on seizures

Aanestad,

Beniczky,

Olberg

et al. 2024

Epileptic Disorders

View full text Add to dashboard Cite

ObjectiveReproducibility is key for diagnostic tests involving subjective evaluation by experts. Our aim was to systematically review the reproducibility of visual analysis in clinical electroencephalogram (EEG). In this paper, we give data on the scope of EEG features found, and detailed reproducibility data for the most studied feature.MethodsWe searched four databases for articles reporting reproducibility in clinical EEG, until June 2023. Two raters screened 24 553 citations, and then 2736 full texts. Quality was assessed according to the GRRAS guidelines.ResultsWe found 275 studies (268 interrater and 20 intrarater), addressing 606 different EEG features. Only 38 EEG features had been studied in >2 studies. Most studies had <50 patients and EEGs. The most often addressed feature was seizure detection (62 papers). Interrater reproducibility of seizure detection was substantial‐to‐almost‐perfect with experienced raters and raw EEG (kappa .62–.88). With experienced raters and transformed EEG, reproducibility was substantial (kappa .63–.70). Inexperienced raters had lower reproducibility. Seizure lateralization reproducibility was moderate to substantial (kappa .58–.77) but lower than for seizure detection.SignificanceMost EEG reproducibility studies are done only once. Intrarater studies are rare. The reproducibility of visual EEG analysis is variable. Interrater reproducibility for seizure detection is substantial‐to‐perfect with experienced raters and raw EEG, less with inexperienced raters or transformed EEG.The results of visual EEG analysis vary within the same rater, and between raters. There is a need for larger collaborative studies, using improved methodology, as well as more intrarater studies of EEG interpretation.

show abstract

Electroencephalographic reactivity testing in unconscious patients: a systematic review of methods and definitions

Cited by 47 publications

References 29 publications

Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study

Early electroencephalography for outcome prediction of postanoxic coma: A prospective cohort study

Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Unveiling variability: A systematic review of reproducibility in visual EEG analysis, with focus on seizures

Contact Info

Product

Resources

About