Inter-rater reliability of amplitude-integrated EEG for the detection of neonatal seizures

Abhijeet A Rakshasbhuvankar; Deepika Wagh; Sam E Athikarisamy; Jonathan Davis; Elizabeth A Nathan; Linda Palumbo; Soumya Ghosh; Lakshmi Nagarajan; Shripada C Rao

doi:10.1016/j.earlhumdev.2020.105011

Inter-rater reliability of amplitude-integrated EEG for the detection of neonatal seizures

Early Hum Dev. 2020 Apr:143:105011. doi: 10.1016/j.earlhumdev.2020.105011. Epub 2020 Mar 4.

Authors

Abhijeet A Rakshasbhuvankar¹, Deepika Wagh², Sam E Athikarisamy², Jonathan Davis², Elizabeth A Nathan³, Linda Palumbo⁴, Soumya Ghosh⁵, Lakshmi Nagarajan⁶, Shripada C Rao²

Affiliations

¹ Neonatal Clinical Care Unit, King Edward Memorial Hospital and Perth Children's Hospital, Perth, Australia; Centre for Neonatal Research and Education, Medical School, University of Western Australia, Australia. Electronic address: abhijeet.rakshasbhuvankar@health.wa.gov.au.
² Neonatal Clinical Care Unit, King Edward Memorial Hospital and Perth Children's Hospital, Perth, Australia; Centre for Neonatal Research and Education, Medical School, University of Western Australia, Australia.
³ Women and Infants Research Foundation, King Edward Memorial Hospital, Perth, Australia; Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Australia.
⁴ Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Perth, Australia.
⁵ Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Perth, Australia; Centre for Neuromuscular and Neurological Disorders, Perron Institute, University of Western Australia, Perth, Australia.
⁶ Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Perth, Australia; Division of Paediatrics and Child Health, Medical School, University of Western Australia, Perth, Australia.

PMID: 32145502
DOI: 10.1016/j.earlhumdev.2020.105011

Abstract

Background: Amplitude-integrated electroencephalogram (aEEG) is being used increasingly for seizure detection in neonates. However, data regarding inter-rater reliability among neonatologists for the use of aEEG for the detection of neonatal seizures is lacking.

Methods: Term and late-preterm infants at risk of seizures were monitored simultaneously with 24-h video-electroencephalography (vEEG) and aEEG. vEEG was interpreted by an experienced neurologist. Five neonatologists with experience in aEEG interpretation from four different neonatal units interpreted aEEG recordings independently. The Brennan and Prediger kappa coefficient and Intra-class Correlation Coefficients (ICC) were used to assess inter-rater reliability between the neonatologists.

Results: Thirty-five infants at risk of seizure with gestational age at birth 35-42 weeks were recruited for the study after informed parental consent. vEEG detected seizures in seven infants with a total of 169 individual seizure episodes. Neonatologists detected seizures in 10 to 15 infants on aEEG. The sensitivities for the detection of individual seizures by neonatologists ranged from 18% to 38%. The inter-rater reliability for detection of: individual seizure was "fair" (kappa = 0.37; 95% CI: 0.32-0.42), infant with seizure was "moderate" (kappa = 0.60; 95% CI: 0.44-0.75), duration of individual seizure (ICC: 0.22; 95% CI: 0.18-0.28) and total duration of seizures in an infant (ICC: 0.46; 95% CI: 0.30-0.63) was "poor". The neonatologists missed 77-90% of the duration of seizures.

Conclusion: The inter-rater reliability of aEEG for the detection of neonatal seizures was suboptimal. Even when interpreted by experienced and trained clinicians, seizure detection with aEEG has limitations and can miss large number and duration of seizures.

Keywords: Cerebral function monitor; Diagnostic study; Neonatal seizure.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Electroencephalography / methods
Electroencephalography / standards*
Epilepsy, Benign Neonatal / diagnosis*
Female
Humans
Infant, Newborn
Male
Observer Variation
Seizures / diagnosis*