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Observational Study
. 2017 Nov;34(6):534-541.
doi: 10.1097/WNP.0000000000000424.

Interrater Agreement of EEG Interpretation After Pediatric Cardiac Arrest Using Standardized Critical Care EEG Terminology

Nicholas S Abend  1 , Shavonne L Massey, Mark Fitzgerald, France Fung, Natalie J Atkin, Rui Xiao, Alexis A Topjian
Affiliations
Observational Study

Interrater Agreement of EEG Interpretation After Pediatric Cardiac Arrest Using Standardized Critical Care EEG Terminology

Nicholas S Abend et al. J Clin Neurophysiol. 2017 Nov.

Abstract

Purpose: We evaluated interrater agreement of EEG interpretation in a cohort of critically ill children resuscitated after cardiac arrest using standardized EEG terminology.

Methods: Four pediatric electroencephalographers scored 10-minute EEG segments from 72 consecutive children obtained 24 hours after return of circulation using the American Clinical Neurophysiology Society's (ACNS) Standardized Critical Care EEG terminology. The percent of perfect agreement and the kappa coefficient were calculated for each of the standardized EEG variables and a predetermined composite EEG background category.

Results: The overall background category (normal, slow-disorganized, discontinuous, or attenuated-featureless) had almost perfect agreement (kappa 0.89).The ACNS Standardized Critical Care EEG variables had agreement that was (1) almost perfect for the seizures variable (kappa 0.93), (2) substantial for the continuity (kappa 0.79), voltage (kappa 0.70), and sleep transient (kappa 0.65) variables, (3) moderate for the rhythmic or periodic patterns (kappa 0.55) and interictal epileptiform discharge (kappa 0.60) variables, and (4) fair for the predominant frequency (kappa 0.23) and symmetry (kappa 0.31) variables. Condensing variable options led to improved agreement for the continuity and voltage variables.

Conclusions: These data support the use of the standardized terminology and the composite overall background category as a basis for standardized EEG interpretation for subsequent studies assessing EEG background for neuroprognostication after pediatric cardiac arrest.

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Figures

Figure 1
Figure 1
Example images for the Overall Background Category variable. The images show normal (delta activity with symmetric sleep spindles), slow and disorganized (delta activity), discontinuity (periods of activity separated by low-amplitude periods), burst suppression (bursts of activity separated by low-amplitude inter-burst intervals), and attenuation-featureless (highly attenuated with no higher voltage periods) patterns.
See this image and copyright information in PMC

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