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Published on: January 29, 2014
Reliability in the assessment of paediatric somatosensory evoked potentials post cardiac arrest
William M McDevitt1, Laura Quinn2, Peter R Bill1
1Department of Neurophysiology, Birmingham Women's and Children's NHS Foundation Trust, UK.
Insights
Inter-rater agreement for interpreting somatosensory evoked potentials (SSEPs) in pediatric cardiac arrest survivors showed substantial consistency. However, agreement decreased significantly in younger children and those with poor outcomes, highlighting potential variability in SSEP interpretation.
Area of Science:
- Neuroscience
- Clinical Neurophysiology
Background:
- Cortical somatosensory evoked potentials (SSEPs) are used to assess neurological function in pediatric patients following cardiac arrest (CA).
- Accurate interpretation of SSEP components is crucial for prognostication in this vulnerable population.
Purpose of the Study:
- To evaluate the inter- and intra-rater agreement in the interpretation of SSEP components among multi-professional neurophysiology teams.
- To identify factors influencing agreement in SSEP interpretation after pediatric CA.
Main Methods:
- Thirteen neurophysiology professionals interpreted 96 SSEPs from pediatric CA patients at 24, 48, and 72 hours post-event.
- Duplicate interpretations were used to assess intra-rater agreement, and Fleiss' kappa coefficient (K) was employed to quantify agreement rates.
Main Results:
- Unanimous agreement was observed in 40% of SSEP interpretations, with an average kappa (K) of 0.62.
- Agreement was comparable between scientists (K=0.62) and neurophysiologists (K=0.67).
- Significantly lower agreement was found in patients younger than 2 years (K=0.23) and those with poor outcomes (K=0.21).
Conclusions:
- While substantial agreement exists in prognostic SSEP interpretation, variability increases in younger pediatric patients and those with poor neurological outcomes.
- Clinicians should exercise caution regarding inter-rater variability, particularly when interpreting SSEPs as absent in critically ill children.
Objective:
To measure inter- and intra-rater agreement in the interpretation of cortical somatosensory evoked potential (SSEP) components following paediatric cardiac arrest (CA) in multi-professional neurophysiology teams.
Methods:
Thirteen professionals blinded to patient outcome interpreted 96 SSEPs in paediatric patients 24-/48-/72-hours following CA. Of these, 34 were duplicates used to assess intra-rater agreement. Consistent interpretations (absent/present/indeterminate) between scientists (who record/identify SSEP components) and neurophysiologists (who provide prognostic SSEP interpretation) were expressed as percentages. Rates of agreement were calculated using Fleiss' kappa coefficient (K).
Results:
Unanimous agreement between professionals was present in 40% (95%CI: 28-54%) of the interpreted SSEPs, with a K value of 0.62 (95%CI: 0.55-0.70) based on average agreement. Agreement was similar between neurophysiologists (K = 0.67; 95%CI: 0.57-0.77) and scientists (K = 0.62; 95%CI: 0.54-0.70) but lower in patients < 2 years old (K = 0.23; 95%CI: 0.14-0.33) and in those with poor outcome (K = 0.21; 95%CI: 0.07-0.35). No SSEP was unanimously interpreted as absent and 92% (95%CI: 89-95%) of duplicate SSEPs were interpreted consistently.
Conclusion:
Despite substantial agreement when interpreting prognostic SSEPs, this was significantly lower in children with poor outcome and of younger age.
Significance:
Clinicians using SSEPs in the intensive care unit should be aware of the inter-rater variability when interpreting SSEPs as absent.
