title: Prospective assessment and validation of rhythmic and periodic pattern detection in NeuroTrend: A new approach for screening continuous EEG in the intensive care unit.
abstract: BACKGROUND
  NeuroTrend is a computational method that analyzes long-term scalp EEGs in the ICU according to ACNS standardized critical care EEG terminology (CCET) including electrographic seizures. At present, it attempts to become a screening aid for continuous EEG (cEEG) recordings in the ICU to facilitate the review process and optimize resources.
  
  
  METHODS
  A prospective multicenter study was performed in two neurological ICUs including 68 patients who were subjected to video-cEEG. Two reviewers independently annotated the first minute of each hour in the cEEG according to CCET. These segments were also screened for faster patterns with frequencies higher than 4 Hz. The matching annotations (2911 segments) were then used as gold standard condition to test sensitivity and specificity of the rhythmic and periodic pattern detection of NeuroTrend.
  
  
  RESULTS
  Interrater agreement showed substantial agreement for localization (main term 1) and pattern type (main term 2) of the CCET. The overall detection sensitivity of NeuroTrend was 94% with high detection rates for periodic discharges (PD = 80%) and rhythmic delta activity (RDA = 82%). Overall specificity was moderate (67%) mainly because of false positive detections of RDA in cases of general slowing. In contrast, a detection specificity of 88% for PDs was reached. Localization revealed only a slight agreement between reviewers and NeuroTrend.
  
  
  CONCLUSIONS
  NeuroTrend might be a suitable screening tool for cEEG in the ICU and has the potential to raise efficiency of long-term EEG monitoring in the ICU. At this stage, pattern localization and differentiation between RDA and general slowing need improvement. This article is part of a Special Issue entitled "Status Epilepticus".
authors.affiliation: Department of Neurosurgery, Medical University of Vienna, Vienna, Austria. Electronic address: johannes.herta@meduniwien.ac.at.
authors.forename: J
authors.initials: J
authors.lastname: Herta
authors.affiliation: Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, 2nd Neurological Department, General Hospital Hietzing with Neurological Center Rosenhuegel, Vienna, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Koren
authors.affiliation: AIT Austrian Institute of Technology GmbH, Digital Safety & Security Department, Vienna, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Fürbass
authors.affiliation: AIT Austrian Institute of Technology GmbH, Digital Safety & Security Department, Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Hartmann
authors.affiliation: AIT Austrian Institute of Technology GmbH, Digital Safety & Security Department, Vienna, Austria.
authors.forename: T
authors.initials: T
authors.lastname: Kluge
authors.affiliation: Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, 2nd Neurological Department, General Hospital Hietzing with Neurological Center Rosenhuegel, Vienna, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Baumgartner
authors.affiliation: Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Gruber
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D003422:Critical Care / Q000379:methods*; D003627:Data Interpretation, Statistical; D003700:Delta Rhythm; D004569:Electroencephalography / Q000379:methods* / Q000706:statistics & numerical data*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012015:Reference Standards; D012680:Sensitivity and Specificity; D013226:Status Epilepticus / Q000175:diagnosis / Q000628:therapy
keywords: Automatic; Continuous EEG; Epileptic seizure detection; Intensive care unit; Prospective multicenter study; Screening device