title: Seizure Detection by Critical Care Providers Using Amplitude-Integrated Electroencephalography and Color Density Spectral Array in Pediatric Cardiac Arrest Patients.
abstract: OBJECTIVE
  Determine the accuracy and confidence of critical care medicine providers to identify seizures using amplitude-integrated electroencephalography versus amplitude-integrated electroencephalography combined with color density spectral array electroencephalography (aEEG + CDSA).
  
  
  METHODS
  Tutorial and questionnaire.
  
  
  METHODS
  PICU.
  
  
  METHODS
  Pediatric critical care providers (attendings, fellows, and nurses).
  
  
  METHODS
  A standardized powerpoint tutorial on amplitude-integrated electroencephalography and color density spectral array followed by classification of 100 amplitude-integrated electroencephalography images and 100 amplitude-integrated electroencephalography combined with color density spectral array as displaying seizures or not displaying seizures.
  
  
  RESULTS
  Electroencephalography tracings were obtained from children monitored with continuous electroencephalography after cardiac arrest. The gold standard for seizure identification was continuous electroencephalography interpretation by a pediatric electroencephalographer. The same electroencephalography tracings were used to generate images containing only amplitude-integrated electroencephalography or aEEG + CDSA. Twenty-three critical care medicine providers underwent a 30-minute tutorial on amplitude-integrated electroencephalography and color density spectral array interpretation. They were then asked to determine if there were seizures on 100 amplitude-integrated electroencephalography images and 100 aEEG + CDSA. Amplitude-integrated electroencephalography seizure detection sensitivity was 77% (95% CI, 73%-80%), specificity of 65% (95% CI, 62%-67%), negative predictive value of 88% (95% CI, 86%-90%), and positive predictive value of 46% (95% CI, 43%-49%). For aEEG + CDSA, sensitivity was 77% (95% CI, 74%-81%), specificity of 68% (95% CI, 66%-71%), negative predictive value of 89% (95% CI, 87%-90%), and positive predictive value of 49% (95% CI, 46%-52%). Sensitivity for status epilepticus detection was 77% (95% CI, 71%-82%) with amplitude-integrated electroencephalography and 75% (95% CI, 69%-81%) with aEEG + CDSA. The addition of color density spectral array to amplitude-integrated electroencephalography did not improve seizure detection. However, 87% of critical care medicine providers qualitatively felt that combining both modalities increased their ability to detect seizures.
  
  
  CONCLUSIONS
  Amplitude-integrated electroencephalography and aEEG + CDSA offer reasonable sensitivity and negative predictive value for seizure detection by critical care medicine providers. aEEG + CDSA did not improve seizure detection over amplitude-integrated electroencephalography alone although critical care medicine providers felt more confident using both tools combined. Amplitude-integrated electroencephalography and color density spectral array require further evaluation as a tool for screening for seizures and should only be used in conjunction with professional continuous electroencephalography review.
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 3Departments of Neurology and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Du Pont-Thibodeau
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Sanchez
authors.forename: Abbas F
authors.initials: AF
authors.lastname: Jawad
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Topjian
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods*; D004569:Electroencephalography / Q000379:methods*; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012640:Seizures / Q000175:diagnosis* / Q000209:etiology; D012680:Sensitivity and Specificity