Non-neurophysiologist Physicians and Nurses Can Detect Subclinical Seizures in Children Using a Panel of Quantitative...

Area of Science:

• Neuroscience
• Pediatric Critical Care
• Quantitative Electroencephalography (qEEG)

Background:

• Nonconvulsive seizures are difficult to detect in pediatric intensive care units (PICUs).
• Early identification of seizures is crucial for timely intervention and improved patient outcomes.
• Quantitative EEG (qEEG) offers potential tools for seizure detection.

Purpose of the Study:

• To evaluate the sensitivity and specificity of quantitative EEG (qEEG) trends for detecting nonconvulsive seizures.
• To assess the ability of non-neurophysiologist clinicians (pediatric residents and nurses) to use qEEG trends for seizure detection.
• To determine the interrater agreement among clinicians using qEEG trends.

Main Methods:

• Retrospective analysis of 45 one-hour qEEG epochs from 10 pediatric ICU patients with 184 electrographic seizures.
• Epochs included qEEG trends, seizure probability markers, automated detectors, rhythmicity spectrograms, and amplitude-integrated EEG.
• Six pediatric residents and five ICU nurses analyzed epochs after brief training, compared to a gold standard epileptologist interpretation.

Main Results:

• Pediatric residents and ICU nurses achieved a sensitivity of 0.90 for seizure detection.
• Specificity was 0.87 for residents and 0.89 for nurses.
• Interrater agreement was moderate (kappa 0.45-0.59); neurophysiologists achieved higher accuracy (sensitivity 0.90, specificity 0.93) and agreement (kappa 0.76).

Conclusions:

• A panel of qEEG trends can be effectively used by non-neurophysiologists in pediatric critical care.
• This approach demonstrates reasonable accuracy for detecting nonconvulsive seizures.
• Utilizing qEEG trends may expedite subclinical seizure identification and intervention in critically ill children.