Sahar F Zafar1, Edilberto Amorim2, Craig A Williamsom3, Jin Jing4, Emily J Gilmore5, Hiba A Haider6, Christa Swisher7, Aaron Struck8, Eric S Rosenthal4, Marcus Ng9, Sarah Schmitt10, Jong W Lee11, M Brandon Westover4. 1. Massachusetts General Hospital, Department of Neurology, Boston, MA, USA. Electronic address: sfzafar@mgh.harvard.edu. 2. Massachusetts General Hospital, Department of Neurology, Boston, MA, USA; University of California, Department of Neurology, San Francisco, CA, USA. 3. University of Michigan, Department of Neurosurgery and Neurology, Ann Arbor, MI, USA. 4. Massachusetts General Hospital, Department of Neurology, Boston, MA, USA. 5. Yale School of Medicine, Department of Neurology, New Haven, CT, USA. 6. Emory University School of Medicine, Department of Neurology, Atlanta, GA, USA. 7. Duke University School of Medicine, Department of Neurology, Durham, NC, USA. 8. University of Wisconsin, Department of Neurology, Madison, WI, USA. 9. University of Manitoba, Winnipeg, Canada, USA. 10. University of South Carolina, Department of Neurology, Charleston, SC, USA. 11. Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
Abstract
OBJECTIVE: To determine the inter-rater agreement (IRA) of a standardized nomenclature for EEG spectrogram patterns, and to estimate the probability distribution of ictal-interictal continuum (IIC) patterns vs. other EEG patterns within each category in this nomenclature. METHODS: We defined seven spectrogram categories: "Solid Flames", "Irregular Flames", "Broadband-monotonous", "Narrowband-monotonous", "Stripes", "Low power", and "Artifact". Ten electroencephalographers scored 115 spectrograms and the corresponding raw EEG samples. Gwet's agreement coefficient was used to calculate IRA. RESULTS: Solid Flames represented seizures or IIC patterns 69.4% of the time. Irregular Flames represented seizures or IIC patterns 38.7% of the time. Broadband-monotonous primarily corresponded with seizures or IIC (54.3%) and Narrowband-monotonous with focal or generalized slowing (43.8%). Stripes were associated with burst-suppression (37.2%) and generalized suppression (34.4%). Low Power category was associated with generalized suppression (94%). There was "near perfect" agreement for Solid Flames (κ = 94.36), Low power (κ = 92.61), and Artifact (κ = 93.72). There was "substantial agreement" for all other categories (κ = 74.65-79.49). CONCLUSIONS: This EEG spectrogram nomenclature has high IRA among electroencephalographers. SIGNIFICANCE: The nomenclature can be a useful tool for EEG screening. Future studies are needed to determine if using this nomenclature shortens time to IIC identification, and how best to use it in practice to reduce time to intervention.
OBJECTIVE: To determine the inter-rater agreement (IRA) of a standardized nomenclature for EEG spectrogram patterns, and to estimate the probability distribution of ictal-interictal continuum (IIC) patterns vs. other EEG patterns within each category in this nomenclature. METHODS: We defined seven spectrogram categories: "Solid Flames", "Irregular Flames", "Broadband-monotonous", "Narrowband-monotonous", "Stripes", "Low power", and "Artifact". Ten electroencephalographers scored 115 spectrograms and the corresponding raw EEG samples. Gwet's agreement coefficient was used to calculate IRA. RESULTS: Solid Flames represented seizures or IIC patterns 69.4% of the time. Irregular Flames represented seizures or IIC patterns 38.7% of the time. Broadband-monotonous primarily corresponded with seizures or IIC (54.3%) and Narrowband-monotonous with focal or generalized slowing (43.8%). Stripes were associated with burst-suppression (37.2%) and generalized suppression (34.4%). Low Power category was associated with generalized suppression (94%). There was "near perfect" agreement for Solid Flames (κ = 94.36), Low power (κ = 92.61), and Artifact (κ = 93.72). There was "substantial agreement" for all other categories (κ = 74.65-79.49). CONCLUSIONS: This EEG spectrogram nomenclature has high IRA among electroencephalographers. SIGNIFICANCE: The nomenclature can be a useful tool for EEG screening. Future studies are needed to determine if using this nomenclature shortens time to IIC identification, and how best to use it in practice to reduce time to intervention.
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