Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method

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Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method. / Duez, Christophe Henri Valdemar; Ebbesen, Mads Qvist; Benedek, Krisztina; Fabricius, Martin; Atkins, Mary Doreen; Beniczky, Sandor; Kjaer, Troels W; Kirkegaard, Hans; Johnsen, Birger.

In: Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, Vol. 129, No. 4, 04.2018, p. 724-730.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Harvard

Duez, CHV, Ebbesen, MQ, Benedek, K, Fabricius, M, Atkins, MD, Beniczky, S, Kjaer, TW, Kirkegaard, H & Johnsen, B 2018, 'Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method', Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, vol. 129, no. 4, pp. 724-730. https://doi.org/10.1016/j.clinph.2018.01.054

APA

Duez, C. H. V., Ebbesen, M. Q., Benedek, K., Fabricius, M., Atkins, M. D., Beniczky, S., Kjaer, T. W., Kirkegaard, H., & Johnsen, B. (2018). Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 129(4), 724-730. https://doi.org/10.1016/j.clinph.2018.01.054

CBE

Duez CHV, Ebbesen MQ, Benedek K, Fabricius M, Atkins MD, Beniczky S, Kjaer TW, Kirkegaard H, Johnsen B. 2018. Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 129(4):724-730. https://doi.org/10.1016/j.clinph.2018.01.054

MLA

Duez, Christophe Henri Valdemar et al. "Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method". Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2018, 129(4). 724-730. https://doi.org/10.1016/j.clinph.2018.01.054

Vancouver

Duez CHV, Ebbesen MQ, Benedek K, Fabricius M, Atkins MD, Beniczky S et al. Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2018 Apr;129(4):724-730. https://doi.org/10.1016/j.clinph.2018.01.054

Author

Duez, Christophe Henri Valdemar ; Ebbesen, Mads Qvist ; Benedek, Krisztina ; Fabricius, Martin ; Atkins, Mary Doreen ; Beniczky, Sandor ; Kjaer, Troels W ; Kirkegaard, Hans ; Johnsen, Birger. / Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method. In: Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2018 ; Vol. 129, No. 4. pp. 724-730.

Bibtex

@article{6c4caa808ec24ce88c955d4ac722ac65,
title = "Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method",
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.",
keywords = "Coma prognosis, EEG reactivity, Inter-rater variation, Outcome prediction, Quantitative EEG",
author = "Duez, {Christophe Henri Valdemar} and Ebbesen, {Mads Qvist} and Krisztina Benedek and Martin Fabricius and Atkins, {Mary Doreen} and Sandor Beniczky and Kjaer, {Troels W} and Hans Kirkegaard and Birger Johnsen",
note = "Copyright {\textcopyright} 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.",
year = "2018",
month = apr,
doi = "10.1016/j.clinph.2018.01.054",
language = "English",
volume = "129",
pages = "724--730",
journal = "Clinical Neurophysiology",
issn = "1388-2457",
publisher = "Elsevier Ireland Ltd.",
number = "4",

}

RIS

TY - JOUR

T1 - Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method

AU - Duez, Christophe Henri Valdemar

AU - Ebbesen, Mads Qvist

AU - Benedek, Krisztina

AU - Fabricius, Martin

AU - Atkins, Mary Doreen

AU - Beniczky, Sandor

AU - Kjaer, Troels W

AU - Kirkegaard, Hans

AU - Johnsen, Birger

N1 - Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

PY - 2018/4

Y1 - 2018/4

N2 - 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.

AB - 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.

KW - Coma prognosis

KW - EEG reactivity

KW - Inter-rater variation

KW - Outcome prediction

KW - Quantitative EEG

UR - http://www.scopus.com/inward/record.url?scp=85041795508&partnerID=8YFLogxK

U2 - 10.1016/j.clinph.2018.01.054

DO - 10.1016/j.clinph.2018.01.054

M3 - Journal article

C2 - 29448148

VL - 129

SP - 724

EP - 730

JO - Clinical Neurophysiology

JF - Clinical Neurophysiology

SN - 1388-2457

IS - 4

ER -