Abstracts

Rationale: Increasing awareness about nonconvulsive seizure requires continuous EEG (cEEG). However, EEG interpretation requires a highly-specialized skill as well as this is a labor and time-intensive process. Continuous EEG screening using qEEG trend guide by neurological residents and technicians who expectedly lack extensive EEG training and experience, has shorter review times with minimal loss of sensitivity for seizure detection when compared with visual analysis of raw EEG. In this study, we aimed to investigate the diagnostic utility of these methods by neurological residents and technicians for electrographic identification in the critical care adult. Methods: Six-hour epochs (n = 34) were collected retrospectively from ICU underwent transformation into qEEG trend. EEG trends consisted of the amplitude intergrade EEG, density spectral array, asymmetry index and rhythmic spectrogram. Each epoch was reviewed by neurosurgery resident who had no experience EEG or qEEG reading. Epileptologist reviewed raw EEGs to identify seizures to serve as the gold standard. After training for seizure identification with continuous EEG (cEEG) and qEEG. Two neurology resident and two technicians reviewed raw EEG and qEEG simultaneously and marked seizure timing. We evaluated sensitivity for seizure detection, false-positive rates for seizure detection and median review time compared conventional review by epileptologist. Results: The overall accuracy was 82% of the electrographic seizure were detection by all. The sensitivities and specificities are 0.81 and 0.65, respectively. False positive rates were 0.1 per 6 hours in the study. Ictal recording with lower amplitude, ictal intermixed with frequency artifacts, slow frequency ictal recording and background with periodic pattern were more likely to be miss. Median time were shorter for qEEG guide review compared with page by page review (p < 0.001). There was no difference in performance between the rating of neurological resident and technician. Conclusions: A qEEG trend guide review cEEG can be used by neurological resident and technician to shorten EEG review time, good sensitivity and low false positive rate. Funding: Faculty of Medicine Research Fund, Prince of Songkla University, Songkhla, Thailand