Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method.
Clin Neurophysiol
; 129(4): 724-730, 2018 04.
Article
de En
| MEDLINE
| ID: mdl-29448148
ABSTRACT
OBJECTIVE:
To assess inter-rater agreement on EEG-reactivity (EEG-R) in comatose patients and compare it with a quantitative method (QEEG-R).METHODS:
Six 30-s stimulation epochs (noxious, visual and auditory) were performed during EEG on 19 neurosurgical and 11 cardiac arrest patients. Six experts analysed EEGs for reactivity using their habitual methods. QEEG-R was defined as present if ≥2/6 epochs were reactive (stimulation/rest power ratio exceeding noise level). Three-months patient outcome was assessed by the Cerebral Performance Category Score (CPC) dichotomized in good (1-2) or poor (3-5).RESULTS:
Agreement among experts on overall EEG-R varied from 53% to 83% (κ 0.05-0.64) and reached 100% (κ 1) between two QEEG-R calculators. For the experts, absence of EEG-R yielded sensitivities for poor outcome between 40-85% and specificities between 20-90%, for QEEG-R sensitivity was 40% (CI 23-68%) and specificity 100% (CI 69-100%).CONCLUSIONS:
There is a large inter-rater variation among experts on EEG-R assessment in comatose patients. QEEG-R is a promising objective prognostic parameter with low inter-rater variation and a high specificity for prediction of poor outcome.SIGNIFICANCE:
Clinicians should be cautious when using the traditional, qualitative method, in particular in end-of-life decisions. Implementation of the quantitative method in clinical practice may improve reliability of reactivity assessments.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Médecins
/
Coma
/
Électroencéphalographie
Type d'étude:
Diagnostic_studies
/
Prognostic_studies
/
Qualitative_research
Limites:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Langue:
En
Journal:
Clin Neurophysiol
Sujet du journal:
NEUROLOGIA
/
PSICOFISIOLOGIA
Année:
2018
Type de document:
Article