J J Halford1, D Shiau2, J A Desrochers2, B J Kolls3, B C Dean4, C G Waters4, N J Azar5, K F Haas5, E Kutluay6, G U Martz6, S R Sinha3, R T Kern2, K M Kelly7, J C Sackellares8, S M LaRoche9. 1. Department of Neurology, Medical University of South Carolina, Charleston, SC, USA. Electronic address: halfordj@musc.edu. 2. Optima Neurosciences Inc., Alachua, FL, USA. 3. Department of Neurology, Duke University Medical Center, Durham, NC, USA. 4. School of Computing, Clemson University, Clemson, SC, USA. 5. Department of Neurology, Vanderbilt University, Nashville, TN, USA. 6. Department of Neurology, Medical University of South Carolina, Charleston, SC, USA. 7. Center for Neuroscience Research, Allegheny Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA, USA. 8. Department of Neurology, Malcolm Randal VA Medical Center, Gainesville, FL, USA. 9. Department of Neurology, Emory University Hospital, Atlanta, GA, USA.
Abstract
OBJECTIVE: This study investigated inter-rater agreement (IRA) among EEG experts for the identification of electrographic seizures and periodic discharges (PDs) in continuous ICU EEG recordings. METHODS: Eight board-certified EEG experts independently identified seizures and PDs in thirty 1-h EEG segments which were selected from ICU EEG recordings collected from three medical centers. IRA was compared between seizure and PD identifications, as well as among rater groups that have passed an ICU EEG Certification Test, developed by the Critical Care EEG Monitoring Research Consortium (CCEMRC). RESULTS: Both kappa and event-based IRA statistics showed higher mean values in identification of seizures compared to PDs (k=0.58 vs. 0.38; p<0.001). The group of rater pairs who had both passed the ICU EEG Certification Test had a significantly higher mean IRA in comparison to rater pairs in which neither had passed the test. CONCLUSIONS:IRA among experts is significantly higher for identification of electrographic seizures compared to PDs. Additional instruction, such as the training module and certification test developed by the CCEMRC, could enhance this IRA. SIGNIFICANCE: This study demonstrates more disagreement in the labeling of PDs in comparison to seizures. This may be improved by education about standard EEG nomenclature. Published by Elsevier Ireland Ltd.
RCT Entities:
OBJECTIVE: This study investigated inter-rater agreement (IRA) among EEG experts for the identification of electrographic seizures and periodic discharges (PDs) in continuous ICU EEG recordings. METHODS: Eight board-certified EEG experts independently identified seizures and PDs in thirty 1-h EEG segments which were selected from ICU EEG recordings collected from three medical centers. IRA was compared between seizure and PD identifications, as well as among rater groups that have passed an ICU EEG Certification Test, developed by the Critical Care EEG Monitoring Research Consortium (CCEMRC). RESULTS: Both kappa and event-based IRA statistics showed higher mean values in identification of seizures compared to PDs (k=0.58 vs. 0.38; p<0.001). The group of rater pairs who had both passed the ICU EEG Certification Test had a significantly higher mean IRA in comparison to rater pairs in which neither had passed the test. CONCLUSIONS: IRA among experts is significantly higher for identification of electrographic seizures compared to PDs. Additional instruction, such as the training module and certification test developed by the CCEMRC, could enhance this IRA. SIGNIFICANCE: This study demonstrates more disagreement in the labeling of PDs in comparison to seizures. This may be improved by education about standard EEG nomenclature. Published by Elsevier Ireland Ltd.
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