Electrographic Seizure Detection by Neuroscience Intensive Care Unit Nurses via Bedside Real-Time Quantitative EEG

Area of Science:

• Neuroscience
• Critical Care Medicine
• Neurology

Background:

• Continuous EEG (cEEG) monitoring is crucial for seizure detection in neuro-ICU patients.
• Timely seizure detection and interpretation are vital for effective patient management.
• Current standard of care for EEG interpretation can involve delays.

Purpose of the Study:

• To evaluate the performance of neuro-ICU nurses in real-time bedside interpretation of quantitative EEG (qEEG) for seizure detection.
• To compare nurse-led seizure detection time with the standard of care.
• To identify factors influencing nurse accuracy in qEEG interpretation.

Main Methods:

• Nurses received training on a 1-hour qEEG panel (spectrogram and amplitude-integrated EEG).
• Hourly nurse interpretations were compared against a gold standard of neurophysiologist review of cEEG.
• Diagnostic performance metrics (sensitivity, specificity) and time to detection were analyzed.

Main Results:

• Nurse sensitivity for seizure detection was 74%, with a specificity of 92%.
• Seizure detection by nurses was significantly faster than the standard of care by 132 minutes.
• Inaccurate interpretations were linked to longer monitoring hours and brief rhythmic discharges.

Conclusions:

• Real-time nurse interpretation of qEEG in the neuro-ICU demonstrates clinically adequate performance for seizure detection.
• This approach offers a significant improvement in the speed of seizure detection compared to the standard of care.