Seizure Detection by Critical Care Providers Using Amplitude-Integrated Electroencephalography and Color Density Spectral Array in Pediatric Cardiac Arrest Patients.
Seizure Detection by Critical Care Providers Using Amplitude-Integrated Electroencephalography and Color Density Spectral Array in Pediatric Cardiac Arrest Patients.
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DOI：
10.1097/pcc.0000000000001099
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发表时间：
2017-04
期刊：
影响因子：
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通讯作者：
Topjian AA
中科院分区：
文献类型：
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作者：
Du Pont-Thibodeau G;Sanchez SM;Jawad AF;Nadkarni VM;Berg RA;Abend NS;Topjian AA
确定CCM提供者使用振幅整合EEG（aEEG）与aEEG结合彩色密度频谱阵列脑电图（aEEG+CDSA）教程和问卷识别癫痫发作的准确性和置信度。儿科重症监护提供者（主治医生、研究员、护士）。关于aEEG和CDSA的标准化PowerPoint教程，随后将100幅aEEG图像和100幅aEEG与CDSA结合分类为显示癫痫发作或未显示癫痫发作。从心脏骤停后连续EEG监测的儿童中获得了EEG描记。癫痫发作识别的金标准是由儿科脑电图仪进行连续脑电图解释。使用相同的EEG描记来生成仅包含aEEG或aEEG+CDSA的图像。23名CCM提供者接受了关于aEEG和CDSA解释的30分钟教程。然后，他们被要求确定100 aEEG图像和100 aEEG+CDSA是否有癫痫发作。aEEG检测癫痫发作的敏感性为77%（95%CI：73%-80%），特异性为65%（95%CI：62%-67%），阴性预测值（NPV）为88%（95%CI：86%-90%），阳性预测值（PPV）为46%（95%CI：43%-49%）。aEEG+CDSA的敏感性为77%（95%CI：74%-81%），特异性为68%（95%CI：66%-71%），NPV为89%（95%CI：87%-90%），PPV为49%（95%CI：46%-52%）。aEEG检测癫痫持续状态的灵敏度为77%（95%CI：71%-82%），aEEG+CDSA检测癫痫持续状态的灵敏度为75%（95%CI：69%-81%）。在aEEG中添加CDSA并没有改善癫痫发作检测。然而，87%的CCM提供者定性地认为，结合这两种方式提高了他们检测癫痫发作的能力。aEEG和aEEG+CDSA为CCM提供者的癫痫发作检测提供了合理的灵敏度和NPV。aEEG+CDSA与单独aEEG相比，并未改善癫痫发作检测，尽管CCM提供者对联合使用两种工具更有信心。aEEG和CDSA需要进一步评估，作为癫痫发作筛查的工具，仅应与专业cEEG检查结合使用。
Determine the accuracy and confidence of CCM providers to identify seizures using amplitude-integrated EEG (aEEG) versus aEEG combined with Color Density Spectral Array electroencephalography (aEEG+CDSA) tutorial and questionnaire. Pediatric critical care providers (attendings, fellows, nurses). A standardized powerpoint tutorial on aEEG and CDSA followed by classification of 100 aEEG images and 100 aEEG combined with CDSA as displaying seizures or not displaying seizures. EEG tracings were obtained from children monitored with continuous EEG after cardiac arrest. The gold standard for seizure identification was continuous EEG interpretation by a pediatric electroencephalographer. The same EEG tracings were used to generate images containing only aEEG or aEEG+CDSA. Twenty-three CCM providers underwent a 30-minute tutorial on aEEG and CDSA interpretation. They were then asked to determine if there were seizures on 100 aEEG images and 100 aEEG+CDSA. aEEG seizure detection sensitivity was 77% (95%CI: 73%–80%), specificity of 65% (95%CI: 62%–67%), negative predictive value (NPV) of 88% (95%CI: 86%–90%) and positive predictive value (PPV) of 46% (95%CI: 43%–49%). For aEEG+CDSA, sensitivity was 77% (95%CI: 74%–81%), specificity of 68% (95%CI: 66%–71%), NPV of 89% (95%CI: 87%–90%) and PPV of 49% (95%CI: 46%–52%). Sensitivity for status epilepticus detection was 77% (95%CI: 71%–82%) with aEEG and 75% (95%CI: 69%–81%) with aEEG+CDSA. The addition of CDSA to aEEG did not improve seizure detection. However, 87% of CCM providers qualitatively felt that combining both modalities increased their ability to detect seizures. aEEG and aEEG+CDSA offer reasonable sensitivity and NPV for seizure detection by CCM providers. aEEG+CDSA did not improve seizure detection over aEEG alone, although CCM providers felt more confident using both tools combined. aEEG and CDSA require further evaluation as a tool for screening for seizures and should only be used in conjunction with professional cEEG review.