The effectiveness of neurology resident EEG training for seizure recognition in critically ill patients

EEG monitoring in the ICU is essential for diagnosing seizures in critically ill patients. Neurology residents are the frontline for rapid diagnosis of seizures. Residents received EEG training through didactic lectures and their epilepsy rotations. We hypothesized that seizure recognition was dependent on epilepsy rotation, not the seniority of the residency. Residents were taught ACNS Standardized Critical Care EEG Terminology, unified EEG terminology and criteria for non-convulsive status epilepticus. EEG segments were given to residents for seizure recognition, and explanations provided to residents after each test. Anonymous results with the postgraduate training year (PGY) and time spent in epilepsy rotation were collected. These tests were conducted 3 times, with total of 48 EEG segments, between October, 2017 and May, 2019. There were 43 participates, including 4 PGY-1 (9.3%), 20 PGY-2 (46.5%), 12 PGY-3 (27.9%), and 7 PGY-4 (16.3%) residents. The mean rate of seizure recognition was 57.1% in PGY-1, 63.8% in PGY-2, 58.4% in PGY-3, and 70.1% in PGY-4. Comparing the duration of epilepsy rotations, the mean correct scores of seizure recognition were 58.6%, 64.6%, 64.4%, and 67.3% for duration at 0, 0.5, 1, and 2 months respectively. There was no significant difference regarding the PGY or the time of epilepsy rotation statistically by ANOVA (p = 0.37). Seizure recognition in the EEG of a critically ill patient is not solely dependent time spent in epilepsy rotation or stage of residency training. EEG interpretation skill may require an alternate approach, and continuous training.