American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version.
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ABSTRACT:
SUBMITTER: Hirsch LJ
PROVIDER: S-EPMC8135051 | biostudies-literature | 2021 Jan
REPOSITORIES: biostudies-literature
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American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version.
Hirsch Lawrence J LJ Fong Michael W K MWK Leitinger Markus M LaRoche Suzette M SM Beniczky Sandor S Abend Nicholas S NS Lee Jong Woo JW Wusthoff Courtney J CJ Hahn Cecil D CD Westover M Brandon MB Gerard Elizabeth E EE Herman Susan T ST Haider Hiba Arif HA Osman Gamaleldin G Rodriguez-Ruiz Andres A Maciel Carolina B CB Gilmore Emily J EJ Fernandez Andres A Rosenthal Eric S ES Claassen Jan J Husain Aatif M AM Yoo Ji Yeoun JY So Elson L EL Kaplan Peter W PW Nuwer Marc R MR van Putten Michel M Sutter Raoul R Drislane Frank W FW Trinka Eugen E Gaspard Nicolas N
Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society 20210101 1
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Project description:The interpretation of critical care electroencephalography (EEG) studies is challenging because of the presence of many periodic and rhythmic patterns of uncertain clinical significance. Defining the clinical significance of these patterns requires standardized terminology with high interrater agreement (IRA). We sought to evaluate IRA for the final, published American Clinical Neurophysiology Society (ACNS)-approved version of the critical care EEG terminology (2012 version). Our evaluation included terms not assessed previously and incorporated raters with a broad range of EEG reading experience.After reviewing a set of training slides, 49 readers independently completed a Web-based test consisting of 11 identical questions for each of 37 EEG samples (407 questions). Questions assessed whether a pattern was an electrographic seizure; pattern location (main term 1), pattern type (main term 2); and presence and classification of eight other key features ("plus" modifiers, sharpness, absolute and relative amplitude, frequency, number of phases, fluctuation/evolution, and the presence of "triphasic" morphology).IRA statistics (? values) were almost perfect (90-100%) for seizures, main terms 1 and 2, the +S modifier (superimposed spikes/sharp waves or sharply contoured rhythmic delta activity), sharpness, absolute amplitude, frequency, and number of phases. Agreement was substantial for the +F (superimposed fast activity) and +R (superimposed rhythmic delta activity) modifiers (66% and 67%, respectively), moderate for triphasic morphology (58%), and fair for evolution (21%).IRA for most terms in the ACNS critical care EEG terminology is high. These terms are suitable for multicenter research on the clinical significance of critical care EEG patterns. A PowerPoint slide summarizing this article is available for download in the Supporting Information section http://dx.doi.org/10.1111/epi.12653/supinfo.
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Project description:PurposeElectroencephalography (EEG) remains the gold standard for identifying rhythmic and periodic patterns in critically ill patients. Residents have frequent exposures to EEG and critically ill patients during their training. Our study aimed to assess resident competency in the use of the American Clinical Neurophysiology Society (ACNS) critical care EEG terminology.MethodsAfter self-guided reading and a 2-hour session reviewing the ACNS critical care EEG Terminology training slides, 16 adult neurology residents (PGY 2-4) completed the ACNS certification test. Performance scores were reported as average percent agreement (PA%) with a previously established 5-member expert panel. Interrater agreement was calculated to gauge consensus among peers within the resident cohort. Self-reported comfort levels using the terminology were also obtained.ResultsThe overall pass rate for our cohort was 50% and the median score was 74%. The terms with the highest PA% were: seizures (86.4%), main term 1 (78%), main term 2 (74%). Interrater agreement scores (kappa values) were almost perfect for seizure, and substantial for main terms 1 and 2.ConclusionsOur data suggests that with minimal investment, adult neurology residents at various stages of training can effectively learn the ACNS critical care EEG Terminology.
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