Periodic and Rhythmic Patterns in Critically Ill Children: Incidence and Interrater Agreement
Abstract number :
1.15
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2021
Submission ID :
1825675
Source :
www.aesnet.org
Presentation date :
12/4/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
Nicholas Abend, MD - Children's Hospital of Philadelphia / University of Pennsylvania; Sudha Kessler, MD - Children's Hospital of Philadelphia / University of Pennsylvania; Darshana Parikh, BA - Children's Hospital of Philadelphia; Lisa Vala, REEGT,, RN - Children's Hospital of Philadelphia; Maureen Donnelly, REEGT - Children's Hospital of Philadelphia; Marin Jacobwitz, NP - Children's Hospital of Philadelphia; Alexis Topjian, MD - Children's Hospital of Philadelphia / University of Pennsylvania; France Fung, MD - Children's Hospital of Philadelphia / University of Pennsylvania
Rationale: We aimed to determine the incidence of periodic and rhythmic patterns in critically ill children who underwent continuous EEG monitoring (CEEG) and to evaluate the interrater agreement of pediatric electroencephalographers scores using standardized American Clinical Neurophysiology Society terminology.
Methods: This was a prospective single-center observational study of consecutive critically ill children undergoing CEEG between April 2017 and November 2020. A primary electroencephalographer identified the earliest portion of the EEG tracing which contained periodic or rhythmic patterns. Two pediatric electroencephalographers independently scored a one-hour EEG epoch using standardized critical care EEG terminology (Table). Scoring disagreements were reviewed together to establish a final assessment by consensus. We determined the incidence of periodic and rhythmic patterns and evaluated interrater agreement using Cohen’s Kappa.
Results: The study assessed 1399 patients who underwent CEEG. Electrographic seizures occurred in 345/1399 subjects (25%). Periodic or rhythmic patterns occurred in 142/1399 subjects (10%). Seizures and periodic or rhythmic patterns occurred in 81/1399 subjects (6%). Among the 142 subjects with periodic or rhythmic patterns, the most frequent were GPD 43 (30%), LPD 34 (24%), GRDA 34 (24%), BIPD 14 (10%), and LRDA 11 (8%). MFPD, GSpW, and LSpW patterns were rare. Inter-rater agreement for key standardized terminology was nearly perfect or substantial, and combining response categories for prevalence, duration, and frequency led to improvements in inter-rater agreement. Agreement was almost perfect for main term 1, lateralized main term 1 modifier, main term 2, periodic or rhythmic patterns, plus features presence, prevalence (as 3 variable responses, improved from substantial with the full 5 variable responses), and IIC types. Agreement was substantial for generalized main term 1 modifier, frequency (as 3 variable responses, improved from moderate with the full 5 variable responses), duration (as 3 variable responses, improved from moderate with the full 7 variable responses), evolution, and each of the plus modifiers (superimposed fast or rhythmic or sharp/spike activity). Agreement was moderate for bilateral/multi-focal main term 1 modifier, voltage absolute, and voltage relative. Agreement was fair for sharpness. Agreement was fair for phases.
Conclusions: Periodic or rhythmic patterns occur in about 10% of critically ill children who undergo EEG monitoring. The most frequent patterns were GPD, LPD, GRDA, BIPD, and LRDA. Inter-rater agreement for key standardized terminology is nearly perfect or substantial.
Funding: Please list any funding that was received in support of this abstract.: NIH, Wolfson Foundation.
Neurophysiology