Objective: To determine the accuracy and reliability of electroencephalographic seizure detection by critical care providers using color density spectral array electroencephalography.
Design: Tutorial and questionnaire.
Subjects: Critical care providers (attending physicians, fellow trainees, and nurses).
Interventions: 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.
Measurements and main 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%).
Conclusion: 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.