title: Detection of electrographic seizures by critical care providers using color density spectral array after cardiac arrest is feasible.
abstract: OBJECTIVE
  To determine the accuracy and reliability of electroencephalographic seizure detection by critical care providers using color density spectral array electroencephalography.
  
  
  METHODS
  Tutorial and questionnaire.
  
  
  METHODS
  Critical care providers (attending physicians, fellow trainees, and nurses).
  
  
  METHODS
  A standardized powerpoint color density spectral array tutorial followed by classification of 200 color density spectral array images as displaying seizures or not displaying seizures.
  
  
  RESULTS
  Using conventional electroencephalography recordings obtained from patients who underwent electroencephalography monitoring after cardiac arrest, we created 100 color density spectral array images, 30% of which displayed seizures. The gold standard for seizure category was electroencephalographer determination from the full montage conventional electroencephalography. Participants did not have access to the conventional electroencephalography tracings. After completing a standardized color density spectral array tutorial, images were presented to participants in duplicate and in random order. Twenty critical care physicians (12 attendings and eight fellows) and 19 critical care nurses classified the color density spectral array images as having any seizure(s) or no seizures. The 39 critical care providers had a color density spectral array seizure detection sensitivity of 70% (95% CI, 67-73%), specificity of 68% (95% CI, 67-70%), positive predictive value of 46%, and negative predictive value of 86%. The sensitivity of color density spectral array detection of status epilepticus was 72% (95% CI, 69-74%).
  
  
  CONCLUSIONS
  Determining which post-cardiac arrest patients experience electrographic seizures by critical care providers is feasible after a brief training. There is moderate sensitivity for seizure and status epilepticus detection and a high negative predictive value.
authors: 1Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA. 2Department of Anesthesia and Critical Care Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 3Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 4Department of Neurology, Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 5Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Alexis A
authors: AA
authors: Topjian
authors: Michael
authors: M
authors: Fry
authors: Abbas F
authors: AF
authors: Jawad
authors: Susan T
authors: ST
authors: Herman
authors: Vinay M
authors: VM
authors: Nadkarni
authors: Rebecca
authors: R
authors: Ichord
authors: Robert A
authors: RA
authors: Berg
authors: Dennis J
authors: DJ
authors: Dlugos
authors: Nicholas S
authors: NS
authors: Abend
mesh_terms: D003422:Critical Care / Q000379:methods; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D007318:Inservice Training; D008297:Male; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D015203:Reproducibility of Results; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology*; D012815:Signal Processing, Computer-Assisted
references: Brain. 2014 May;137(Pt 5):1429-38
references: 24595203
references: Neurocrit Care. 2014 Feb;20(1):32-9
references: 24052456
references: Neurology. 2009 Jun 2;72(22):1931-40
references: 19487651
references: Nat Rev Neurosci. 2008 May;9(5):331-43
references: 18382465
references: J Neurosci. 2008 Mar 5;28(10):2527-38
references: 18322097
references: Pediatrics. 2007 Oct;120(4):770-7
references: 17908764
references: Pediatr Neurol. 2007 Jun;36(6):366-72
references: 17560497
references: Arch Neurol. 2006 Dec;63(12):1750-5
references: 17172615
references: Emerg Med Australas. 2006 Feb;18(1):45-50
references: 16454774
references: J Clin Neurophysiol. 2004 Sep-Oct;21(5):353-78
references: 15592009
references: Biometrics. 1977 Mar;33(1):159-74
references: 843571
references: Pediatrics. 2002 May;109(5):772-9
references: 11986435
references: Pediatrics. 2010 Feb;125(2):e358-66
references: 20100767
references: Epilepsia. 2010 Jul;51(7):1198-204
references: 20163439
references: Neurology. 2010 Oct 26;75(17):1501-8
references: 20861452
references: Neurology. 2011 Mar 22;76(12):1071-7
references: 21307352
references: Epilepsia. 2011 Jun;52(6):1130-6
references: 21671924
references: Epilepsia. 2011 Nov;52(11):1973-8
references: 22003955
references: J Clin Monit Comput. 2011 Oct;25(5):329-37
references: 22009108
references: Pediatrics. 2012 Mar;129(3):e748-55
references: 22331332
references: Intensive Care Med. 2012 May;38(5):853-62
references: 22491938
references: Neurocrit Care. 2012 Aug;17(1):3-23
references: 22528274
references: Neurology. 2014 Feb 4;82(5):396-404
references: 24384638
references: J Clin Neurophysiol. 2013 Aug;30(4):371-5
references: 23912575
references: Epilepsia. 2013 Aug;54(8):1419-27
references: 23848569
references: Neurology. 2013 Jul 23;81(4):383-91
references: 23794680
references: Pediatr Crit Care Med. 2013 Jul;14(6):601-9
references: 23823196
references: J Clin Neurophysiol. 2013 Apr;30(2):156-60
references: 23545766
references: Crit Care Med. 2013 Jan;41(1):215-23
references: 23164815
references: Neurocrit Care. 2012 Aug;17(1):31-8
references: 22565632