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Updated: Feb 14, 2026

Isokinetic Robotic Device to Improve Test-Retest and Inter-Rater Reliability for Stretch Reflex Measurements in Stroke Patients with Spasticity
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Large inter-rater variability on EEG-reactivity is improved by a novel quantitative method.

Christophe Henri Valdemar Duez1, Mads Qvist Ebbesen2, Krisztina Benedek3

  • 1Research Center for Emergency Medicine, Aarhus University and Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.

Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology
|February 16, 2018
PubMed
Summary

Expert assessment of electroencephalogram reactivity (EEG-R) in comatose patients shows significant variation. A quantitative EEG-R method offers a more reliable and specific prognostic tool for predicting patient outcomes.

Keywords:
Coma prognosisEEG reactivityInter-rater variationOutcome predictionQuantitative EEG

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Area of Science:

  • Neuroscience
  • Critical Care Medicine
  • Neurology

Background:

  • Assessing electroencephalogram reactivity (EEG-R) is crucial for prognostication in comatose patients.
  • Traditional qualitative EEG-R assessment by experts exhibits considerable inter-rater variability.
  • A need exists for more objective and reliable methods to evaluate EEG-R.

Purpose of the Study:

  • To evaluate the inter-rater agreement for electroencephalogram reactivity (EEG-R) among experts in comatose patients.
  • To compare the reliability of traditional EEG-R assessment with a quantitative EEG-R (QEEG-R) method.
  • To assess the prognostic value of both methods for predicting patient outcomes.

Main Methods:

  • EEG recordings were obtained during noxious, visual, and auditory stimulation in neurosurgical and cardiac arrest patients.
  • Six experts qualitatively assessed EEG reactivity using their standard methods.
  • A quantitative EEG-R (QEEG-R) method was applied, defining reactivity based on stimulation/rest power ratios.

Main Results:

  • Inter-rater agreement among experts for EEG-R varied widely (53%-83%), with kappa values ranging from 0.05 to 0.64.
  • The quantitative QEEG-R method demonstrated perfect agreement (100%, κ=1) between calculators.
  • While expert EEG-R showed variable sensitivity and specificity for poor outcome, QEEG-R had 40% sensitivity and 100% specificity.

Conclusions:

  • Significant inter-rater variability exists in the qualitative assessment of EEG-R in comatose patients.
  • Quantitative EEG-R (QEEG-R) is a promising objective prognostic parameter with low variability and high specificity for poor outcomes.
  • Implementing QEEG-R could enhance the reliability of reactivity assessments in clinical practice, aiding in critical decision-making.