Interrater agreement of the diagnosis and classification of a first seizure in childhood. The Dutch Study of Epilepsy in Childhood

Abstract

Objective: To assess the interrater agreement of the diagnosis and the classification of a first paroxysmal event in childhood. Methods: The descriptions of 100 first paroxysmal events were submitted to two panels each consisting of three experienced paediatric neurologists. Each observer independently made a diagnosis based on clinical judgment and thereafter a diagnosis based on predefined descriptive criteria. Then, the observers discussed all patients within their panel. The agreement between the six individual observers was assessed before discussion within each panel and after that, between the two panels. Results: Using their clinical judgement, the individual observers reached only fair to moderate agreement on the diagnosis of a first seizure (mean (SE) kappa 0.41 (0.03)). With use of defined descriptive criteria the mean (SE) kappa was 0.45 (0.03). The kappa for agreement between both panels after intra-panel discussion increased to 0.60 (0.06). The mean (SE) kappa for the seizure classification by individual observers was 0.46 (0.02) for clinical judgment and 0.57 (0.03) with use of criteria. After discussion within each panel the kappa between the panels was 0.69 (0.06). In 24 out of 51 children considered to have had a seizure, agreement was reached between the panels on a syndrome diagnosis. However, the epileptic syndromes were in most cases only broadly defined. Conclusions: The interrater agreement on the diagnosis of a first seizure in childhood is just moderate. This phenomenon hampers the interpretation of studies on first seizures in which the diagnosis is only made by one observer. The use of a panel increased the interrater agreement considerably. This approach is recommended at least for research purposes. Classification into clinically relevant syndromes is possible only in a very small minority of children with a single seizure.

Interobserver agreement of the old and the newly proposed ILAE epilepsy classification in children

“…found in the current study are slightly lower than that reported in previous studies (Bodensteiner et al, 1988;Lanska et al, 1996;Nordli et al, 1997;Berg et al, 1999;Stroink et al, 2004). However, results from different studies cannot be easily compared because of differences in patient cohorts, type, and amount of data used, experience of the observers, and the number of categories used for classification (i.e., all studies used their own adaptation of the classification schemes to make them suitable for applying statistics).…”

Interobserver Agreement in the Assessment of Clinical Findings in Children With First Unprovoked Seizures

“…1,4,5 The generally modest interrater agreement in our study should not be surprising, as reliability has been only moderate among neurologists when independently assessing whether an event was actually a seizure, as well as the classification of the seizure. 9 Although no previous studies have evaluated interobserver agreement of clinical findings in children with unprovoked seizures when evaluated by acute care physicians (eg, ED practitioners), our results are similar to those found in the assessments of children in other clinical circumstances, and when assessments were made by neurologists. One study noted at least moderate agreement among pediatric neurologists for seizure focality ( ϭ 0.58) and seizure duration Ն10 minutes ( ϭ 0.75) in children with febrile seizures.…”

The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal events

“…PNES were found in 12 children (10 girls). Their median age was 14 years (range [8][9][10][11][12][13][14][15][16][17]. Of these, only three children with concomitant epilepsy were mentally retarded.…”