Diagnostic accuracy between readers for identifying electrographic seizures in critically ill adults
Autor: | Nadege J. Assassi, Jan Claassen, Jay Varma, Mika Sarkela, Linda M. Eerikäinen, Bin Tu, Stephan A. Mayer, Agnieszka Kokoszka, G. Bryan Young, Andres Rodriguez-Ruiz |
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Rok vydání: | 2017 |
Předmět: |
Pediatrics
medicine.medical_specialty Diagnostic accuracy Status epilepticus Electroencephalography 03 medical and health sciences Epilepsy 0302 clinical medicine Intensive care Medicine Continuous EEG monitoring Coma medicine.diagnostic_test Critically ill business.industry Full‐Length Original Research 030208 emergency & critical care medicine medicine.disease Critical care Neurology Equivocal seizures Anesthesia Laterality Interreader agreement Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery |
Zdroj: | Epilepsia Open |
ISSN: | 2470-9239 |
Popis: | SummaryObjective Electrographic seizures in critically ill patients are often equivocal. In this study, we sought to determine the diagnostic accuracy of electrographic seizure annotation in adult intensive care units (ICUs) and to identify affecting factors. Methods To investigate diagnostic accuracy, interreader agreement (IRA) measures were derived from 5,769 unequivocal and 6,263 equivocal seizure annotations by five experienced electroencephalogram (EEG) readers after reviewing 74 days of EEGs from 50 adult ICU patients. Factors including seizure equivocality (unequivocal vs. equivocal) and laterality (generalized, partial, or bilaterally independent), cyclicity (cyclic vs. noncyclic), persistency (occurrence of status epilepticus), and patient consciousness level (coma vs. noncoma) were further investigated for their influence on IRA measures. Results On average, 70% of seizures marked by a reference reader overlapped, at least in part, with those marked by a test reader (any-overlap sensitivity, AO-Sn). Agreed seizure duration between reader pairs (overlap-integral sensitivity, OI-Sn) was 62%, while agreed nonseizure duration (overlap-integral specificity, OI-Sp) was 99%. A test reader would annotate one additional seizure not overlapping with a reference reader's annotation in every 11.7 h of EEG, that is, the false-positive rate (FPR) was 0.0854/h. Classifying seizure patterns into unequivocal and equivocal improved specificity and FPR (unequivocal patterns) but compromised sensitivity only for equivocal patterns. Sensitivity of all and unequivocal annotations was higher for patients with status epilepticus. Specificity was higher for partial than for bilaterally independent unequivocal seizure patterns, and lower for cyclic all seizure patterns. Significance Diagnosing electrographic seizures in critically ill adults is highly specific and moderately sensitive. Improved criteria for diagnosing electrographic seizures in the ICU are needed. |
Databáze: | OpenAIRE |
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