Non-expert use of the cerebral function monitor for neonatal seizure detection
Non-expert use of the cerebral function monitor for neonatal seizure detection
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DOI：
10.1136/fn.89.1.f37
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发表时间：
2004-01-01
影响因子：
4.4
通讯作者：
Hooper, R
中科院分区：
文献类型：
--
作者：
Rennie, JM;Chorley, G;Hooper, R
背景：脑功能监测仪(CFM)被广泛用于检测新生儿癫痫发作，但将其与同步脑电(EEG)进行比较的研究很少。目的：确定非专家使用CFM的准确性，并评估CFM癫痫检测的观察者间一致性。患者：住进国王学院医院新生儿重症监护室的高危新生儿，进行视频脑电监测。在脑电中，每个婴儿都以6、15和30厘米/小时的速度进行CFM记录。四名接受过CFM癫痫识别培训的新生儿专家以三种速度对每个婴儿一小时的CFM样本进行独立评级。观察者间的一致性用Cohen‘s kappa值进行量化。结果：分析了19例有脑电发作的婴儿和21例未发生脑电发作的婴儿的CFM轨迹。总体来说，与同步脑电相比，CFM作为癫痫检测器的非专家解释表现不佳(6 cm/h时灵敏度为38%；15 cm/h时为54%；30 cm/h时为55%)。虽然有癫痫发作的婴儿在较快的速度下更有可能被正确分类(p=0.02)，但没有癫痫发作的婴儿也更有可能被错误分类(p<；0.001)。观察员之间的一致性在任何速度下都不好(kappa值在0.01到0.39之间)。观察者通常能发现全面性发作，但经常漏诊局灶性、低波幅或持续时间不到一分钟的发作。新生儿癫痫发作需要首先使用脑电进行诊断、表征和量化。然后，CFM可能会对长期监测有用。
Background: The cerebral function monitor (CFM) is widely used to detect neonatal seizures, but there are very few studies comparing it with simultaneous electroencephalography (EEG).Objective: To determine the accuracy of non-expert use of the CFM and to assess interobserver agreement of CFM seizure detection.Patients: Babies admitted to the neonatal intensive care unit at King's College Hospital who were at high risk of seizure and had video-EEG monitoring.Methods: Video-EEG was used to detect seizures. Each baby had CFM recordings at speeds of 6, 15, and 30 cm/h during the EEG. Four neonatologists, trained in CFM seizure recognition, independently rated one hour CFM samples at three speeds from each baby. Interobserver agreement was quantified using Cohen's kappa.Results: CFM traces from 19 babies with EEG seizures and 21 babies without EEG seizures were analysed. Overall non-expert interpretation of the CFM performed poorly as a seizure detector compared with simultaneous EEG (sensitivities 38% at 6 cm/h; 54% at 15 cm/h; 55% at 30 cm/h). Although babies with seizures were more likely to be correctly classified at higher speeds (p = 0.02), babies without seizures were also more likely to be misclassified (p < 0.001). Agreement between observers was not good at any speed (kappa values from 0.01 to 0.39). The observers usually detected generalised seizures but often missed seizures that were focal, low amplitude, or lasted less than one minute.Conclusion: Approximately half of all neonatal seizures may be missed using CFM alone. Neonatal seizures need to be diagnosed, characterised, and quantified first using EEG. The CFM may then be useful for long term monitoring.