title: Inter-rater agreement on identification of electrographic seizures and periodic discharges in ICU EEG recordings.
abstract: OBJECTIVE
  This study investigated inter-rater agreement (IRA) among EEG experts for the identification of electrographic seizures and periodic discharges (PDs) in continuous ICU EEG recordings.
  
  
  METHODS
  Eight board-certified EEG experts independently identified seizures and PDs in thirty 1-h EEG segments which were selected from ICU EEG recordings collected from three medical centers. IRA was compared between seizure and PD identifications, as well as among rater groups that have passed an ICU EEG Certification Test, developed by the Critical Care EEG Monitoring Research Consortium (CCEMRC).
  
  
  RESULTS
  Both kappa and event-based IRA statistics showed higher mean values in identification of seizures compared to PDs (k=0.58 vs. 0.38; p<0.001). The group of rater pairs who had both passed the ICU EEG Certification Test had a significantly higher mean IRA in comparison to rater pairs in which neither had passed the test.
  
  
  CONCLUSIONS
  IRA among experts is significantly higher for identification of electrographic seizures compared to PDs. Additional instruction, such as the training module and certification test developed by the CCEMRC, could enhance this IRA.
  
  
  CONCLUSIONS
  This study demonstrates more disagreement in the labeling of PDs in comparison to seizures. This may be improved by education about standard EEG nomenclature.
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, SC, USA. Electronic address: halfordj@musc.edu.
authors.forename: J J
authors.initials: JJ
authors.lastname: Halford
authors.affiliation: Optima Neurosciences Inc., Alachua, FL, USA.
authors.forename: D
authors.initials: D
authors.lastname: Shiau
authors.affiliation: Optima Neurosciences Inc., Alachua, FL, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Desrochers
authors.affiliation: Department of Neurology, Duke University Medical Center, Durham, NC, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Kolls
authors.affiliation: School of Computing, Clemson University, Clemson, SC, USA.
authors.forename: B C
authors.initials: BC
authors.lastname: Dean
authors.affiliation: School of Computing, Clemson University, Clemson, SC, USA.
authors.forename: C G
authors.initials: CG
authors.lastname: Waters
authors.affiliation: Department of Neurology, Vanderbilt University, Nashville, TN, USA.
authors.forename: N J
authors.initials: NJ
authors.lastname: Azar
authors.affiliation: Department of Neurology, Vanderbilt University, Nashville, TN, USA.
authors.forename: K F
authors.initials: KF
authors.lastname: Haas
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: E
authors.initials: E
authors.lastname: Kutluay
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: G U
authors.initials: GU
authors.lastname: Martz
authors.affiliation: Department of Neurology, Duke University Medical Center, Durham, NC, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Sinha
authors.affiliation: Optima Neurosciences Inc., Alachua, FL, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Kern
authors.affiliation: Center for Neuroscience Research, Allegheny Singer Research Institute, Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Kelly
authors.affiliation: Department of Neurology, Malcolm Randal VA Medical Center, Gainesville, FL, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Sackellares
authors.affiliation: Department of Neurology, Emory University Hospital, Atlanta, GA, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: LaRoche
mesh_terms: D004569:Electroencephalography / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D015588:Observer Variation; D012189:Retrospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology*
keywords: Continuous monitoring; EEG; ICU EEG monitoring; Inter-rater agreement; Periodic discharge; Seizure detection