Diagnostic accuracy between readers for identifying electrographic seizures in critically ill adults

OBJECTIVE: 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, i...

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Autores principales: Tu, Bin, Young, G. Bryan, Kokoszka, Agnieszka, Rodriguez‐Ruiz, Andres, Varma, Jay, Eerikäinen, Linda M., Assassi, Nadege, Mayer, Stephan A., Claassen, Jan, Särkelä, Mika O. K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5939393/
https://www.ncbi.nlm.nih.gov/pubmed/29750214
http://dx.doi.org/10.1002/epi4.12034
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author Tu, Bin
Young, G. Bryan
Kokoszka, Agnieszka
Rodriguez‐Ruiz, Andres
Varma, Jay
Eerikäinen, Linda M.
Assassi, Nadege
Mayer, Stephan A.
Claassen, Jan
Särkelä, Mika O. K.
author_facet Tu, Bin
Young, G. Bryan
Kokoszka, Agnieszka
Rodriguez‐Ruiz, Andres
Varma, Jay
Eerikäinen, Linda M.
Assassi, Nadege
Mayer, Stephan A.
Claassen, Jan
Särkelä, Mika O. K.
author_sort Tu, Bin
collection PubMed
description OBJECTIVE: 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.
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spelling pubmed-59393932018-05-10 Diagnostic accuracy between readers for identifying electrographic seizures in critically ill adults Tu, Bin Young, G. Bryan Kokoszka, Agnieszka Rodriguez‐Ruiz, Andres Varma, Jay Eerikäinen, Linda M. Assassi, Nadege Mayer, Stephan A. Claassen, Jan Särkelä, Mika O. K. Epilepsia Open Full‐length Original Research OBJECTIVE: 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. John Wiley and Sons Inc. 2017-01-03 /pmc/articles/PMC5939393/ /pubmed/29750214 http://dx.doi.org/10.1002/epi4.12034 Text en © 2016 The Authors. Epilepsia Open published by Wiley Periodicals Inc. on behalf of International League Against Epilepsy. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Full‐length Original Research
Tu, Bin
Young, G. Bryan
Kokoszka, Agnieszka
Rodriguez‐Ruiz, Andres
Varma, Jay
Eerikäinen, Linda M.
Assassi, Nadege
Mayer, Stephan A.
Claassen, Jan
Särkelä, Mika O. K.
Diagnostic accuracy between readers for identifying electrographic seizures in critically ill adults
title Diagnostic accuracy between readers for identifying electrographic seizures in critically ill adults
title_full Diagnostic accuracy between readers for identifying electrographic seizures in critically ill adults
title_fullStr Diagnostic accuracy between readers for identifying electrographic seizures in critically ill adults
title_full_unstemmed Diagnostic accuracy between readers for identifying electrographic seizures in critically ill adults
title_short Diagnostic accuracy between readers for identifying electrographic seizures in critically ill adults
title_sort diagnostic accuracy between readers for identifying electrographic seizures in critically ill adults
topic Full‐length Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5939393/
https://www.ncbi.nlm.nih.gov/pubmed/29750214
http://dx.doi.org/10.1002/epi4.12034
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