Christophe Henri Valdemar Duez1, Mads Qvist Ebbesen2, Krisztina Benedek3, Martin Fabricius4, Mary Doreen Atkins5, Sandor Beniczky6, Troels W Kjaer7, Hans Kirkegaard8, Birger Johnsen9. 1. Research Center for Emergency Medicine, Aarhus University and Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark. Electronic address: Christophe.duez@gmail.com. 2. Department of Clinical Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark. Electronic address: madsebbe@rm.dk. 3. Department of Clinical Neurophysiology, University of Copenhagen, Rigshospitalet, Nordre Ringvej 57, 2600 Glostrup, Denmark. Electronic address: krisztina.benedek@regionh.dk. 4. Department of Clinical Neurophysiology, University of Copenhagen, University of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 København Ø, Denmark. Electronic address: martin.ejler.fabricius@regionh.dk. 5. Department of Clinical Neurophysiology, Zealand University Hospital, 4000 Roskilde, Denmark. Electronic address: mdat@regionsjaelland.dk. 6. Department of Clinical Neurophysiology, Danish Epilepsy Center, Dianalund, Denmark; Department of Clinical Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark. Electronic address: sbz@filadelfia.dk. 7. Department of Clinical Neurophysiology, University of Copenhagen, Zealand University Hospital, 4000 Roskilde, Denmark. Electronic address: neurology@dadlnet.dk. 8. Department of Anaesthesiology and Intensive Care Medicine, Aarhus University Hospital and Aarhus University, Denmark. Electronic address: hanskirkegaard@dadlnet.dk. 9. Department of Clinical Neurophysiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark. Electronic address: birger.johnsen@dadlnet.dk.
Abstract
OBJECTIVE: To assess inter-rater agreement on EEG-reactivity (EEG-R) in comatose patients and compare it with a quantitative method (QEEG-R). METHODS: Six 30-s stimulation epochs (noxious, visual and auditory) were performed during EEG on 19 neurosurgical and 11 cardiac arrest patients. Six experts analysed EEGs for reactivity using their habitual methods. QEEG-R was defined as present if ≥2/6 epochs were reactive (stimulation/rest power ratio exceeding noise level). Three-months patient outcome was assessed by the Cerebral Performance Category Score (CPC) dichotomized in good (1-2) or poor (3-5). RESULTS: Agreement among experts on overall EEG-R varied from 53% to 83% (κ: 0.05-0.64) and reached 100% (κ: 1) between two QEEG-R calculators. For the experts, absence of EEG-R yielded sensitivities for poor outcome between 40-85% and specificities between 20-90%, for QEEG-R sensitivity was 40% (CI: 23-68%) and specificity 100% (CI: 69-100%). CONCLUSIONS: There is a large inter-rater variation among experts on EEG-R assessment in comatose patients. QEEG-R is a promising objective prognostic parameter with low inter-rater variation and a high specificity for prediction of poor outcome. SIGNIFICANCE: Clinicians should be cautious when using the traditional, qualitative method, in particular in end-of-life decisions. Implementation of the quantitative method in clinical practice may improve reliability of reactivity assessments.
OBJECTIVE: To assess inter-rater agreement on EEG-reactivity (EEG-R) in comatosepatients and compare it with a quantitative method (QEEG-R). METHODS: Six 30-s stimulation epochs (noxious, visual and auditory) were performed during EEG on 19 neurosurgical and 11 cardiac arrestpatients. Six experts analysed EEGs for reactivity using their habitual methods. QEEG-R was defined as present if ≥2/6 epochs were reactive (stimulation/rest power ratio exceeding noise level). Three-months patient outcome was assessed by the Cerebral Performance Category Score (CPC) dichotomized in good (1-2) or poor (3-5). RESULTS: Agreement among experts on overall EEG-R varied from 53% to 83% (κ: 0.05-0.64) and reached 100% (κ: 1) between two QEEG-R calculators. For the experts, absence of EEG-R yielded sensitivities for poor outcome between 40-85% and specificities between 20-90%, for QEEG-R sensitivity was 40% (CI: 23-68%) and specificity 100% (CI: 69-100%). CONCLUSIONS: There is a large inter-rater variation among experts on EEG-R assessment in comatosepatients. QEEG-R is a promising objective prognostic parameter with low inter-rater variation and a high specificity for prediction of poor outcome. SIGNIFICANCE: Clinicians should be cautious when using the traditional, qualitative method, in particular in end-of-life decisions. Implementation of the quantitative method in clinical practice may improve reliability of reactivity assessments.
Authors: Edilberto Amorim; Michelle van der Stoel; Sunil B Nagaraj; Mohammad M Ghassemi; Jin Jing; Una-May O'Reilly; Benjamin M Scirica; Jong Woo Lee; Sydney S Cash; M Brandon Westover Journal: Clin Neurophysiol Date: 2019-07-25 Impact factor: 3.708
Authors: Marjolein M Admiraal; Anne-Fleur van Rootselaar; Jeannette Hofmeijer; Cornelia W E Hoedemaekers; Christiaan R van Kaam; Hanneke M Keijzer; Michel J A M van Putten; Marcus J Schultz; Janneke Horn Journal: Ann Neurol Date: 2019-06-08 Impact factor: 10.422