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Seizure Detection by Critical Care Providers Using Amplitude-Integrated Electroencephalography and Color Density
Geneviève Du Pont-Thibodeau1, Sarah M Sanchez, Abbas F Jawad
11Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 3Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Insights
Critical care providers can identify seizures using amplitude-integrated electroencephalography (aEEG) and aEEG with color density spectral array (CDSA), though CDSA did not improve detection accuracy. Providers felt more confident using both tools combined for seizure identification.
Area of Science:
- Neuroscience
- Clinical Medicine
- Medical Technology
Background:
- Seizure detection in pediatric intensive care units (PICU) is crucial for patient management.
- Amplitude-integrated electroencephalography (aEEG) is a simplified EEG monitoring tool.
- Color density spectral array (CDSA) offers a complementary visualization of EEG data.
Purpose of the Study:
- To evaluate the accuracy and confidence of critical care providers in detecting seizures using aEEG alone versus aEEG combined with CDSA (aEEG + CDSA).
- To compare the diagnostic performance of aEEG and aEEG + CDSA for seizure identification in critically ill children.
Main Methods:
- A tutorial on aEEG and aEEG + CDSA interpretation was provided to pediatric critical care providers.
- Providers classified 100 aEEG images and 100 aEEG + CDSA images for the presence of seizures.
- Performance metrics including sensitivity, specificity, and predictive values were calculated against a gold standard interpretation.
Main Results:
- The addition of CDSA to aEEG did not significantly improve seizure detection sensitivity or specificity compared to aEEG alone.
- Negative predictive values for both methods were high (aEEG: 88%, aEEG + CDSA: 89%), indicating good ability to rule out seizures.
- Despite no objective improvement, 87% of providers reported increased confidence in seizure detection when using the combined aEEG + CDSA modality.
Conclusions:
- aEEG and aEEG + CDSA provide reasonable sensitivity and negative predictive value for seizure detection by critical care clinicians.
- While aEEG + CDSA did not enhance objective seizure detection accuracy, it improved provider confidence.
- Further evaluation of aEEG and aEEG + CDSA as screening tools is warranted, emphasizing their use alongside expert continuous EEG review.
Objectives:
Determine the accuracy and confidence of critical care medicine providers to identify seizures using amplitude-integrated electroencephalography versus amplitude-integrated electroencephalography combined with color density spectral array electroencephalography (aEEG + CDSA).
Design:
Tutorial and questionnaire.
Setting:
PICU.
Subjects:
Pediatric critical care providers (attendings, fellows, and nurses).
Interventions:
A standardized powerpoint tutorial on amplitude-integrated electroencephalography and color density spectral array followed by classification of 100 amplitude-integrated electroencephalography images and 100 amplitude-integrated electroencephalography combined with color density spectral array as displaying seizures or not displaying seizures.
Measurements And Main Results:
Electroencephalography tracings were obtained from children monitored with continuous electroencephalography after cardiac arrest. The gold standard for seizure identification was continuous electroencephalography interpretation by a pediatric electroencephalographer. The same electroencephalography tracings were used to generate images containing only amplitude-integrated electroencephalography or aEEG + CDSA. Twenty-three critical care medicine providers underwent a 30-minute tutorial on amplitude-integrated electroencephalography and color density spectral array interpretation. They were then asked to determine if there were seizures on 100 amplitude-integrated electroencephalography images and 100 aEEG + CDSA. Amplitude-integrated electroencephalography seizure detection sensitivity was 77% (95% CI, 73%-80%), specificity of 65% (95% CI, 62%-67%), negative predictive value of 88% (95% CI, 86%-90%), and positive predictive value of 46% (95% CI, 43%-49%). For aEEG + CDSA, sensitivity was 77% (95% CI, 74%-81%), specificity of 68% (95% CI, 66%-71%), negative predictive value of 89% (95% CI, 87%-90%), and positive predictive value of 49% (95% CI, 46%-52%). Sensitivity for status epilepticus detection was 77% (95% CI, 71%-82%) with amplitude-integrated electroencephalography and 75% (95% CI, 69%-81%) with aEEG + CDSA. The addition of color density spectral array to amplitude-integrated electroencephalography did not improve seizure detection. However, 87% of critical care medicine providers qualitatively felt that combining both modalities increased their ability to detect seizures.
Conclusions:
Amplitude-integrated electroencephalography and aEEG + CDSA offer reasonable sensitivity and negative predictive value for seizure detection by critical care medicine providers. aEEG + CDSA did not improve seizure detection over amplitude-integrated electroencephalography alone although critical care medicine providers felt more confident using both tools combined. Amplitude-integrated electroencephalography and color density spectral array require further evaluation as a tool for screening for seizures and should only be used in conjunction with professional continuous electroencephalography review.
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