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Reduced EEG montage has a high accuracy in the post cardiac arrest setting
Sofia Backman1, Tobias Cronberg2, Ingmar Rosén1
1Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Clinical Neurophysiology, Lund, Sweden.
Objective:
To study if comatose cardiac arrest patients can be assessed with a reduced number of EEG electrodes.
Methods:
110 routine EEGs from 67 consecutive patients, including both hypothermic and normothermic EEGs were retrospectively assessed by three blinded EEG-experts using two different electrode montages. A standard 19-electrode-montage was compared to the reduced version of the same EEGs, down-sampled to six electrodes (F3, T3, P3, F4, T4, P4). We used intra-rater and inter-observer statistics to assess the reliability of the reduced montage for background features and discharges.
Results:
The reduced montage had almost perfect performance for background continuity (κ 0.80-0.88), including identification of highly malignant backgrounds (burst-suppression/suppression) (κ 0.85-0.94) and benign backgrounds (continuous/nearly continuous) (κ 0.85-0.91). We found substantial performance for identifying rhythmic/periodic discharges (κ 0.79-0.86). The reduced montage had high accuracy for assessment of both highly malignant (sensitivity 91-95%, specificity 94-99%) and benign (sensitivity 89-98%, specificity 91-96%) backgrounds, and periodic/rhythmic patterns (sensitivity 79-100%, specificity 89-99%), compared to the full montage. The inter-observer variability was not increased by the reduced montage.
Conclusion:
Reduced EEG had high performance for classifying important background and discharge patterns in this post cardiac arrest cohort.
Significance:
Our results support the use of reduced EEG-montage for monitoring comatose cardiac arrest patients.
