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Single-channel amplitude integrated EEG recording for the identification of epileptic seizures by nonexpert physicians in the adult acute care setting

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Abstract

Objective

Although several studies have shown the potential of amplitude integrated electroencephalography (aEEG) in detecting neonatal seizures, no publications have evaluated the diagnostic use of aEEG for the detection of seizures in adult patients.

Methods

In this prospective blinded observational study, bifrontal single-channel electroencephalography (EEG) recordings were performed with a portable EEG monitor (CSM M3 ICU, Danmeter-Goalwick Holdings Limited, Odense, Denmark) during the out-of-hospital care of emergency cases. Four intensive care unit (ICU) physicians received training in the interpretation of aEEG recordings. After the training they evaluated the stored aEEG traces for the presence of epileptic seizure activity during the recording time. The physicians were blinded to the clinical data of the patients. The results obtained were compared with the clinical diagnosis and the evaluation of the raw EEG signal. The level of interrater agreement was quantified using Fleiss’ ĸ.

Results

The aEEG traces from 10 patients with generalized epileptic seizures and 46 patients without seizures were analysed. Overall, the nonexpert ICU physicians failed to identify recordings obtained from patients with seizures reliably, when compared with clinical diagnosis and the single-channel EEG results (mean sensitivity 40%, range 40–60%; mean specificity 89%, range 87–93%). Agreement between observers was high for the cases with seizures ( ĸ = 0.80 ± 0.13). Patients who suffered status epilepticus during the recordings were difficult to identify by most raters.

Conclusion

Recording of aEEG without access to the raw EEG data is not a reliable diagnostic tool for the identification of epileptic seizures in the hands of nonexpert ICU physicians.

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Authors and Affiliations

  1. Center of Anesthesiology and Intensive Care Medicine, Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Rainer Nitzschke MD, Jakob Müller MD & Ria Engelhardt MD

  2. Department of Anesthesiology and Intensive Care Medicine, Asklepios Hospital Altona, Paul-Ehrlich-Strasse 1, 22763, Hamburg, Germany

    Gunter N. Schmidt MD

Authors
  1. Rainer Nitzschke MD
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  2. Jakob Müller MD
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  3. Ria Engelhardt MD
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  4. Gunter N. Schmidt MD
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Corresponding author

Correspondence to Rainer Nitzschke MD.

Additional information

Nitzschke R, Müller J, Engelhardt R, Schmidt GN. Single-channel amplitude integrated EEG recording for the identification of epileptic seizures by nonexpert physicians in the adult acute care setting

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Nitzschke, R., Müller, J., Engelhardt, R. et al. Single-channel amplitude integrated EEG recording for the identification of epileptic seizures by nonexpert physicians in the adult acute care setting. J Clin Monit Comput 25, 329–337 (2011). https://doi.org/10.1007/s10877-011-9312-2

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  • DOI: https://doi.org/10.1007/s10877-011-9312-2

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