Standardized computer-based organized reporting of EEG: SCORE

Abstract

The electroencephalography (EEG) signal has a high complexity, and the process of extracting clinically relevant features is achieved by visual analysis of the recordings. The interobserver agreement in EEG interpretation is only moderate. This is partly due to the method of reporting the findings in free-text format. The purpose of our endeavor was to create a computer-based system for EEG assessment and reporting, where the physicians would construct the reports by choosing from predefined elements for each relevant EEG feature, as well as the clinical phenomena (for video-EEG recordings). A working group of EEG experts took part in consensus workshops in Dianalund, Denmark, in 2010 and 2011. The faculty was approved by the Commission on European Affairs of the International League Against Epilepsy (ILAE). The working group produced a consensus proposal that went through a pan-European review process, organized by the European Chapter of the International Federation of Clinical Neurophysiology. The Standardised Computer-based Organised Reporting of EEG (SCORE) software was constructed based on the terms and features of the consensus statement and it was tested in the clinical practice. The main elements of SCORE are the following: personal data of the patient, referral data, recording conditions, modulators, background activity, drowsiness and sleep, interictal findings, "episodes" (clinical or subclinical events), physiologic patterns, patterns of uncertain significance, artifacts, polygraphic channels, and diagnostic significance. The following specific aspects of the neonatal EEGs are scored: alertness, temporal organization, and spatial organization. For each EEG finding, relevant features are scored using predefined terms. Definitions are provided for all EEG terms and features. SCORE can potentially improve the quality of EEG assessment and reporting; it will help incorporate the results of computer-assisted analysis into the report, it will make possible the build-up of a multinational database, and it will help in training young neurophysiologists.

Figure 1

The interactive screen for scoring EEG studies. The upper left panel (1) contains the flowchart—the main elements to be scored. If an element is not relevant for the recording, it is simply skipped (it does not impose any additional burden). The selection panel (2) contains the features to be scored for the element that was chosen in the flowchart (in this case an interictal finding) and the corresponding choices. The upper row of tabs (3) in this panel shows the features available for scoring. In this example, for interictal findings the available features are: name, location, time-related feature, and modulators. When the “name” feature is active, the selection panel below displays the list of interictal graphoelements. After choosing “sharp-waves” from the name-list, the software automatically shifts to the next feature to be scored (in this example: location). The right lower panel (4) contains a summary of the scored items corresponding to the EEG finding that is being scored. The ribbon at the top (5) contains short-key functions (for example selecting “α” opens directly “Posterior dominant rhythm” with the selection box where frequency values are typed in).