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Interobserver agreement for neonatal seizure detection using multichannel EEG

Stevenson, Nathan J.; Clancy, Robert R.; Vanhatalo, Sampsa; Rosén, Ingmar LU ; Rennie, Janet M. and Boylan, Geraldine B. (2015) In Annals of Clinical and Translational Neurology 2(11). p.1002-1011
Abstract
Objective: To determine the interobserver agreement (IOA) of neonatal seizure detection using the gold standard of conventional, multichannel EEG. Methods: A cohort of full-term neonates at risk of acute encephalopathy was included in this prospective study. The EEG recordings of these neonates were independently reviewed for seizures by three international experts. The IOA was estimated using statistical measures including Fleiss' kappa and percentage agreement assessed over seizure events (event basis) and seizure duration (temporal basis). Results: A total of 4066 h of EEG recordings from 70 neonates were reviewed with an average of 2555 seizures detected. The IOA was high with temporal assessment resulting in a kappa of 0.827 (95% CI:... (More)
Objective: To determine the interobserver agreement (IOA) of neonatal seizure detection using the gold standard of conventional, multichannel EEG. Methods: A cohort of full-term neonates at risk of acute encephalopathy was included in this prospective study. The EEG recordings of these neonates were independently reviewed for seizures by three international experts. The IOA was estimated using statistical measures including Fleiss' kappa and percentage agreement assessed over seizure events (event basis) and seizure duration (temporal basis). Results: A total of 4066 h of EEG recordings from 70 neonates were reviewed with an average of 2555 seizures detected. The IOA was high with temporal assessment resulting in a kappa of 0.827 (95% CI: 0.769-0.865; n = 70). The median agreement was 83.0% (interquartile range [IQR]: 76.6-89.5%; n = 33) for seizure and 99.7% (IQR: 98.9-99.8%; n = 70) for non-seizure EEG. Analysis of events showed a median agreement of 83.0% (IQR: 72.9-86.6%; n = 33) for seizures with 0.018 disagreements per hour (IQR: 0.000-0.090 per hour; n = 70). Observers were more likely to disagree when a seizure was less than 30 sec. Overall, 33 neonates were diagnosed with seizures and 28 neonates were not, by all three observers. Of the remaining nine neonates with contradictory EEG detections, seven presented with low total seizure burden. Interpretation: The IOA is high among experts for the detection of neonatal seizures using conventional, multichannel EEG. Agreement is reduced when seizures are rare or have short duration. These findings support EEG-based decision making in the neonatal intensive care unit, inform EEG interpretation guidelines, and provide benchmarks for seizure detection algorithms. (Less)
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type
Contribution to journal
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published
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in
Annals of Clinical and Translational Neurology
volume
2
issue
11
pages
1002 - 1011
publisher
Wiley-Blackwell
external identifiers
  • wos:000367239800002
  • pmid:26734654
ISSN
2328-9503
DOI
10.1002/acn3.249
language
English
LU publication?
yes
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b2ab3c62-adaa-400e-be1d-3bbdac44c72a (old id 8548659)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/26734654?dopt=Abstract
date added to LUP
2016-02-08 07:21:11
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2016-09-20 04:35:05
@article{b2ab3c62-adaa-400e-be1d-3bbdac44c72a,
  abstract     = {Objective: To determine the interobserver agreement (IOA) of neonatal seizure detection using the gold standard of conventional, multichannel EEG. Methods: A cohort of full-term neonates at risk of acute encephalopathy was included in this prospective study. The EEG recordings of these neonates were independently reviewed for seizures by three international experts. The IOA was estimated using statistical measures including Fleiss' kappa and percentage agreement assessed over seizure events (event basis) and seizure duration (temporal basis). Results: A total of 4066 h of EEG recordings from 70 neonates were reviewed with an average of 2555 seizures detected. The IOA was high with temporal assessment resulting in a kappa of 0.827 (95% CI: 0.769-0.865; n = 70). The median agreement was 83.0% (interquartile range [IQR]: 76.6-89.5%; n = 33) for seizure and 99.7% (IQR: 98.9-99.8%; n = 70) for non-seizure EEG. Analysis of events showed a median agreement of 83.0% (IQR: 72.9-86.6%; n = 33) for seizures with 0.018 disagreements per hour (IQR: 0.000-0.090 per hour; n = 70). Observers were more likely to disagree when a seizure was less than 30 sec. Overall, 33 neonates were diagnosed with seizures and 28 neonates were not, by all three observers. Of the remaining nine neonates with contradictory EEG detections, seven presented with low total seizure burden. Interpretation: The IOA is high among experts for the detection of neonatal seizures using conventional, multichannel EEG. Agreement is reduced when seizures are rare or have short duration. These findings support EEG-based decision making in the neonatal intensive care unit, inform EEG interpretation guidelines, and provide benchmarks for seizure detection algorithms.},
  author       = {Stevenson, Nathan J. and Clancy, Robert R. and Vanhatalo, Sampsa and Rosén, Ingmar and Rennie, Janet M. and Boylan, Geraldine B.},
  issn         = {2328-9503},
  language     = {eng},
  number       = {11},
  pages        = {1002--1011},
  publisher    = {Wiley-Blackwell},
  series       = {Annals of Clinical and Translational Neurology},
  title        = {Interobserver agreement for neonatal seizure detection using multichannel EEG},
  url          = {http://dx.doi.org/10.1002/acn3.249},
  volume       = {2},
  year         = {2015},
}