Objectives: 

To describe implementation and early evaluation of using quantitative electroencephalography for electrographic seizure detection by PICU clinician staff.

Design: 

Prospective observational study of electrographic seizure detection by PICU clinicians in patients monitored with quantitative electroencephalography. Quantitative electroencephalography program implementation included a continuous education and training package. Continuous quantitative electroencephalography monitoring consisted of two-channel amplitude-integrated electroencephalography, color density spectral array, and raw-electroencephalography.

Setting: 

PICU.

Patients: 

Children less than 18 years old admitted to the PICU during the 14-month study period and deemed at risk of electrographic seizure.

Interventions: 

None.

Measurements and Main Results: 

Real time electrographic seizure detection by a PICU team was analyzed for diagnostic accuracy and promptness, against electrographic seizure identification by a trained neurophysiologist, retrospectively reading the same quantitative electroencephalography and blinded to patient details. One-hundred one of 1,510 consecutive admissions (6.7%) during the study period underwent quantitative electroencephalography monitoring. Status epilepticus (35%) and suspected hypoxic-ischemic injury (32%) were the most common indications for quantitative electroencephalography. Electrographic seizure was diagnosed by the neurophysiologist in 12% (n = 12) of the cohort. PICU clinicians correctly diagnosed all 12 patients (100% sensitivity and negative predictive value). An additional eleven patients had a false-positive diagnosis of electrographic seizure (false-positive rate = 52% [31–73%]) leading to a specificity of 88% (79–94%). Median time to detect seizures was 25 minutes (5–218 min). Delayed recognition of electrographic seizure (> 1 hr from onset) occurred in five patients (5/12, 42%).

Conclusions: 

Early evaluation of quantitative electroencephalography program to detect electrographic seizure by PICU clinicians suggested good sensitivity for electrographic seizure detection. However, the high false-positive rate is a challenge. Ongoing work is needed to reduce the false positive diagnoses and avoid electrographic seizure detection delays. A comprehensive training program and regular refresher updates for clinical staff are key components of the program.

中文翻译：

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PICU中癫痫发作定量脑电图程序的实施和早期评估。

目标： 

描述PICU临床医生使用定量脑电图检测癫痫发作的实施和早期评估。

设计： 

定量脑电图监测患者PICU癫痫发作的前瞻性观察研究。定量脑电图计划的实施包括持续的教育和培训包。连续定量脑电图监测包括两通道振幅积分脑电图，色密度谱阵列和原始脑电图。

设置： 

重症监护病房。

耐心： 

在14个月的研究期间内，未满18岁的儿童被录入PICU，并被认为有电图发作的危险。

干预措施： 

没有。

测量和主要结果： 

由PICU团队分析实时电图发作的诊断准确性和及时性，由受过训练的神经生理学家反对电图发作的识别，回顾性地阅读相同的定量脑电图，并对患者的细节不知情。研究期间1,510名连续入院的患者中有一百名（6.7％）接受了定量脑电图监测。癫痫持续状态（35％）和可疑的缺氧缺血性损伤（32％）是定量脑电图的最常见指征。神经电生理学家诊断为电击性癫痫，占12％（n= 12）。PICU临床医生正确诊断了所有12例患者（100％敏感性和阴性预测值）。另有11例患者诊断为电图发作为假阳性（假阳性率= 52％[31–73％]），特异性为88％（79–94％）。检测癫痫发作的中位时间为25分钟（5–218分钟）。五名患者（5 / 12，42％）发生了电子病发作的延迟识别（起病时间> 1小时）。

结论： 

PICU临床医生对定量脑电图程序进行早期评估以检测电图发作的结果表明，对电图发作的检测具有良好的敏感性。然而，高的假阳性率是一个挑战。需要进行持续的工作以减少假阳性诊断并避免电图癫痫发作检测延迟。全面的培训计划和针对临床人员的定期更新是计划的关键组成部分。