Electroencephalography Technologist Inter-rater Agreement and Interpretation of Pediatric Critical Care Electroencephalography

Abstract

Objectives: Electroencephalography (EEG) technologists commonly screen continuous EEG. Until now, the inter-rater agreement or sensitivity for important EEG findings has been unknown in this group. Methods: Twenty-nine EEG technologists and three clinical neurophysiologists interpreted 90 fiveminute samples of pediatric critical care EEG. Inter-rater agreement was examined with Cohen's kappa and Fleiss' kappa for EEG findings. A gold-standard consensus agreement was developed for examining sensitivity and specificity for seizures or discontinuity. Kruskal-Wallis tests with Benjamani-Hochberg corrections for multiple comparisons were utilized to examine associations between correct scoring and certification status and years of experience. Results: Aggregate agreement was moderate for seizures and fair for EEG background continuity among EEG technologists. Individual agreement for seizures and continuity varied from slight to substantial. For individual EEG technologists, sensitivity for seizures ranged from 44 to 93% and sensitivity for continuity ranged from 81 to 100%. Raters with Certified Long Term Monitoring credentials were more likely to identify seizures correctly. Significance: This is the first study to evaluate inter-rater agreement and interpretation correctness among EEG technologists interpreting pediatric critical care EEG. EEG technologists demonstrated better aggregate agreement for seizure detection than other EEG findings, yet individual results and internal consistency varied widely. These data provide important insight into the common practice of utilizing EEG technologists for screening critical care EEG.

United States Epilepsy Center Characteristics

“…However, few hold Certification in Long-Term Monitoring credentials, which may present an opportunity to further improve seizure detection and patient care. 20 …”

Healthcare Professionals' Electroencephalography Competency: A Disconnect Between Self-Assessment and Objective Testing

“…There are a limited number of studies on EEG competence. [13][14][15][16][17][18] Most often, research has focused on the knowledge and skills of nurses to perform continuous EEG monitoring [12][13][14][15][16] because its use has increased especially in intensive care units and there is a lack of trained EEG professionals to be available 24/7. 17,18 There is a lack of studies focusing on, for example, routine standard EEG, which is the most basic EEG method.…”

“…Images of EEG tracings are used to assess HCPs' skills to identify different EEG patterns. [13][14][15][16][17][18] Knowledge test is used to assess nurses' knowledge of EEG fundamentals. 17,18 Subjective self-assessment of EEG competence has been used only rarely in instruments, with questions relating to the participants' current level of comfort with EEG on a scale of 1 to 10.…”

“…Electroencephalography tech interrater agreement was moderate. 13 However, individual results varied widely. 13 The test scores of certificated EEG techs were higher than those of EEG techs not having certification.…”

“…13 However, individual results varied widely. 13 The test scores of certificated EEG techs were higher than those of EEG techs not having certification. 13 Nurses' ability to interpret the EEG signal was weak before training, [16][17][18] and most participants' EEG knowledge remained under passing grade in the test.…”