title: Diagnostic accuracy of EEG changes during carotid endarterectomy in predicting perioperative strokes.
abstract: The 30 day stroke rate following carotid endarterectomy (CEA) ranges between 2-6%. Such periprocedural strokes are associated with a three-fold increased risk of mortality. Our primary aim was to determine the diagnostic accuracy of electroencephalogram (EEG) in predicting perioperative strokes through meta-analysis of existing literature. An extensive search for relevant literature was undertaken using PubMed and Web of Science databases. Studies were included after screening using predetermined criteria. Data was extracted and analyzed. Summary sensitivity, specificity and diagnostic odds ratio were obtained. Subgroup analysis of studies using eight or more EEG channels was done. Perioperative stroke rate for the cohort of 8765 patients was 1.75%. Pooled sensitivity and specificity of EEG changes in predicting these strokes were 52% (95% confidence interval [CI], 43-61%) and 84% (95% CI, 81-86%) respectively. Summary estimates of the subgroup were similar. The diagnostic odds ratio was 5.85 (95% CI, 3.71-9.22). For the observed stroke rate, the positive likelihood ratio was 3.25 while the negative predictive value was 98.99%. According to these results, patients with perioperative strokes have six times greater odds of experiencing an intraoperative change in EEG during CEA. EEG monitoring was found to be highly specific in predicting perioperative strokes after CEA.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Electronic address: thirumalapd@upmc.edu.
authors.forename: Parthasarathy D
authors.initials: PD
authors.lastname: Thirumala
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: Karthy
authors.initials: K
authors.lastname: Thiagarajan
authors.affiliation: Division of Child Neurology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA; Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Satyanarayana
authors.initials: S
authors.lastname: Gedela
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Crammond
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Balzer
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000601:surgery; D004569:Electroencephalography; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012306:Risk; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology
keywords: Carotid endarterectomy; Carotid stenosis; EEG; Intraoperative neurophysiological monitoring; Postoperative complications; Stroke