title: Interobserver agreement for neonatal seizure detection using multichannel EEG.
abstract: To determine the interobserver agreement (IOA) of neonatal seizure detection using the gold standard of conventional, multichannel EEG.
  
  
  
  A cohort of full-term neonates at risk of acute encephalopathy was included in this prospective study. The EEG recordings of these neonates were independently reviewed for seizures by three international experts. The IOA was estimated using statistical measures including Fleiss' kappa and percentage agreement assessed over seizure events (event basis) and seizure duration (temporal basis).
  
  
  
  A total of 4066 h of EEG recordings from 70 neonates were reviewed with an average of 2555 seizures detected. The IOA was high with temporal assessment resulting in a kappa of 0.827 (95% CI: 0.769-0.865; n = 70). The median agreement was 83.0% (interquartile range [IQR]: 76.6-89.5%; n = 33) for seizure and 99.7% (IQR: 98.9-99.8%; n = 70) for nonseizure EEG. Analysis of events showed a median agreement of 83.0% (IQR: 72.9-86.6%; n = 33) for seizures with 0.018 disagreements per hour (IQR: 0.000-0.090 per hour; n = 70). Observers were more likely to disagree when a seizure was less than 30 sec. Overall, 33 neonates were diagnosed with seizures and 28 neonates were not, by all three observers. Of the remaining nine neonates with contradictory EEG detections, seven presented with low total seizure burden.
  
  
  
  The IOA is high among experts for the detection of neonatal seizures using conventional, multichannel EEG. Agreement is reduced when seizures are rare or have short duration. These findings support EEG-based decision making in the neonatal intensive care unit, inform EEG interpretation guidelines, and provide benchmarks for seizure detection algorithms.
authors.affiliation: Neonatal Brain Research Group Irish Centre for Fetal and Neonatal Translational Research University College Cork Cork Ireland.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Stevenson
authors.affiliation: Division of Neurology The Children's Hospital of Philadelphia Philadelphia Pennsylvania; Departments of Neurology and Pediatrics Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Clancy
authors.affiliation: Department of Clinical Neurophysiology HUS Medical Imaging Center Helsinki University Central Hospital and University of Helsinki Helsinki Finland.
authors.forename: Sampsa
authors.initials: S
authors.lastname: Vanhatalo
authors.affiliation: Department of Clinical Neurophysiology Lund University Hospital Lund Sweden.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Rosén
authors.affiliation: Academic Research Department of Neonatology Institute for Women's Health University College London London United Kingdom.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Rennie
authors.affiliation: Neonatal Brain Research Group Irish Centre for Fetal and Neonatal Translational Research University College Cork Cork Ireland.
authors.forename: Geraldine B
authors.initials: GB
authors.lastname: Boylan