title: The standardization debate: A conflation trap in critical care electroencephalography.
abstract: OBJECTIVE
  Persistent uncertainty over the clinical significance of various pathological continuous electroencephalography (cEEG) findings in the intensive care unit (ICU) has prompted efforts to standardize ICU cEEG terminology and an ensuing debate. We set out to understand the reasons for, and a satisfactory resolution to, this debate.
  
  
  METHODS
  We review the positions for and against standardization, and examine their deeper philosophical basis.
  
  
  RESULTS
  We find that the positions for and against standardization are not fundamentally irreconcilable. Rather, both positions stem from conflating the three cardinal steps in the classic approach to EEG, which we term "description", "interpretation", and "prescription". Using real-world examples we show how this conflation yields muddled clinical reasoning and unproductive debate among electroencephalographers that is translated into confusion among treating clinicians. We propose a middle way that judiciously uses both standardized terminology and clinical reasoning to disentangle these critical steps and apply them in proper sequence.
  
  
  CONCLUSIONS
  The systematic approach to ICU cEEG findings presented herein not only resolves the standardization debate but also clarifies clinical reasoning by helping electroencephalographers assign appropriate weights to cEEG findings in the face of uncertainty.
authors.affiliation: Section of Neurology, Department of Internal Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada. Electronic address: mng2@hsc.mb.ca.
authors.forename: Marcus C
authors.initials: MC
authors.lastname: Ng
authors.affiliation: Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA. Electronic address: nicolas.gaspard@yale.edu.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gaspard
authors.affiliation: Epilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ajcole1@mgh.harvard.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cole
authors.affiliation: Epilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: dhoch@mgh.harvard.edu.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Hoch
authors.affiliation: Epilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: scash@mgh.harvard.edu.
authors.forename: Sydney S
authors.initials: SS
authors.lastname: Cash
authors.affiliation: Epilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: mtbianchi@mgh.harvard.edu.
authors.forename: Matt
authors.initials: M
authors.lastname: Bianchi
authors.affiliation: Epilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: daorourke@mgh.harvard.edu.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: O'Rourke
authors.affiliation: Epilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: erosenthal@mgh.harvard.edu.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rosenthal
authors.affiliation: Epilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: cjchu@mgh.harvard.edu.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Chu
authors.affiliation: Epilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: mwestover@mgh.harvard.edu.
authors.forename: M Brandon
authors.initials: MB
authors.lastname: Westover
mesh_terms: D003422:Critical Care / Q000379:methods* / Q000592:standards*; D004569:Electroencephalography / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008991:Monitoring, Physiologic
keywords: Critical care; Electroencephalography; Intensive care; Long-term monitoring; Nomenclature; Standardization