Ronner H E, Ponten S C, Stam C J, Uitdehaag B M J
Department of Clinical Neurophysiology of the VU University Medical Center, Amsterdam, The Netherlands.
Seizure. 2009 May;18(4):257-63. doi: 10.1016/j.seizure.2008.10.010. Epub 2008 Nov 28.
To assess the inter-observer agreement of the electroencephalogram (EEG) diagnosis of (non-convulsive) seizures in comatose patients.
DESIGN/SETTING/PATIENTS: Nine clinicians with different levels of experience in clinical neurophysiology were asked to evaluate in a strictly controlled way 90 epochs (10s each) of 30 EEG's of 23 comatose patients admitted to the intensive care unit (ICU). For each EEG clinicians had to decide whether there was an electrographic seizure or not. Furthermore, Young's EEG criteria for (non-convulsive) seizures were scored in detail for all EEG's. Agreement was determined by calculating kappa values.
The inter-observer agreement of an EEG diagnosis of seizure was limited. The overall kappa score for the five experienced raters was 0.5, and the kappa score for less experienced raters was 0.29. Kappa values for the individual Young's criteria were highly variable, indicating discrepancies in the interpretation of specific phenomena. Especially, some types of periodic discharges gave rise to different interpretations.
The EEG diagnosis of (non-convulsive) seizures in ICU patients is not very reliable, even when strict criteria such as proposed by Young are applied. There is a need for less ambiguous EEG criteria for (non-convulsive) seizures and status epilepticus.
评估昏迷患者脑电图（EEG）对（非惊厥性）癫痫发作诊断的观察者间一致性。
设计/背景/患者：邀请9名在临床神经生理学方面经验水平不同的临床医生，以严格控制的方式对23名入住重症监护病房（ICU）的昏迷患者的30份脑电图中的90个片段（每个片段10秒）进行评估。对于每份脑电图，临床医生必须判断是否存在脑电图癫痫发作。此外，还对所有脑电图详细评分了扬氏（非惊厥性）癫痫发作的脑电图标准。通过计算kappa值来确定一致性。
脑电图癫痫发作诊断的观察者间一致性有限。5名经验丰富的评估者的总体kappa评分为0.5，经验较少的评估者的kappa评分为0.29。各个扬氏标准的kappa值差异很大，表明在对特定现象的解释上存在差异。特别是，某些类型的周期性放电引发了不同的解释。
即使应用扬氏提出的严格标准，ICU患者（非惊厥性）癫痫发作的脑电图诊断也不是非常可靠。需要制定不那么模糊的（非惊厥性）癫痫发作和癫痫持续状态的脑电图标准。
