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Interobserver agreement for neonatal seizure detection using multichannel EEG.

Nathan J Stevenson1, Robert R Clancy2, Sampsa Vanhatalo3

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Annals of Clinical and Translational Neurology
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Summary
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Expert review of neonatal seizures using electroencephalogram (EEG) shows high interobserver agreement (IOA). Agreement decreases for rare or brief seizures, supporting EEG use in neonatal care and algorithm development.

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Area of Science:

  • Neonatal neurology
  • Clinical neurophysiology

Background:

  • Neonatal seizures are a critical concern in acute encephalopathy.
  • Accurate detection of neonatal seizures is essential for timely intervention.

Purpose of the Study:

  • To assess the interobserver agreement (IOA) in detecting neonatal seizures using conventional, multichannel electroencephalogram (EEG).
  • To establish the reliability of expert interpretation of neonatal EEG for seizure detection.

Main Methods:

  • Prospective study of full-term neonates at risk of acute encephalopathy.
  • Independent review of EEG recordings by three international experts.
  • Statistical analysis of IOA using Fleiss' kappa and percentage agreement (temporal and event basis).

Main Results:

  • High IOA observed, with temporal assessment yielding a kappa of 0.827.
  • Median agreement for seizure detection was 83.0% on an event basis.
  • Agreement was reduced for seizures shorter than 30 seconds.

Conclusions:

  • Conventional multichannel EEG demonstrates high interobserver agreement for neonatal seizure detection.
  • Findings support the use of EEG for clinical decision-making in neonatal intensive care units.
  • Results provide benchmarks for automated seizure detection algorithms and inform interpretation guidelines.