Interobserver reproducibility of electroencephalogram interpretation in critically ill children

Correct outcome prediction after cardiac arrest in children may improve clinical decision making and family counseling. Investigators have used EEG to predict outcome with varying success, but a limiting issue is the potential lack of reproducibility of EEG interpretation. Therefore, the authors aimed to evaluate interobserver agreement using standardized terminology in the interpretation of EEG tracings obtained from critically ill children after cardiac arrest. Three pediatric neurophysiologists scored 74 EEG samples using standardized categories, terminology, and interpretation rules. Interobserver agreement was evaluated using kappa and intraclass correlation coefficients. Agreement was substantial for the categories of continuity, burst suppression, sleep architecture, and overall rating. Agreement was moderate for seizure occurrence and interictal epileptiform discharge type. Agreement was fair for interictal epileptiform discharge presence, beta activity, predominant frequency, and fastest frequency. Agreement was slight for maximum voltage and focal slowing presence. The variability of interrater agreement suggests that some EEG features are superior to others for use in a predictive algorithm. Using only reproducible EEG features is needed to ensure the most accurate and consistent predictions. Because even seizure identification had only moderate agreement, studies of nonconvulsive seizures in critically ill patients must be conducted and interpreted cautiously.