Malone Aileen, Ryan C Anthony, Fitzgerald Anthony, Burgoyne Louise, Connolly Sean, Boylan Geraldine B
Department of Paediatrics and Child Health, University College Cork, Ireland.
Epilepsia. 2009 Sep;50(9):2097-101. doi: 10.1111/j.1528-1167.2009.02132.x. Epub 2009 Jun 1.
Accurate diagnosis of neonatal seizures is critically important and is often made clinically, without EEG (electroencephalography) monitoring. This observational study aimed to determine the accuracy and interobserver reliability of healthcare professionals in distinguishing clinically manifested seizures from other neonatal movements, when presented with clinical histories and digital video recordings only.
Twenty digital video recordings of paroxysmal movements in term and preterm infants were selected from a video-EEG database. The movements were categorized as seizure and nonseizure using EEG. Health care professionals (n = 137) from eight neonatal intensive care units (NICUs) were shown the video recordings with additional relevant clinical data, excluding EEG findings. The observers were asked to indicate which movements they considered to be seizure or nonseizure. A multirater Kappa statistic was used to assess agreement between observers and with the true diagnosis.
Twenty video clips (11 seizure, 9 nonseizure) were evaluated by 91 doctors and 46 other professionals. The average number of correctly identified events was 10/20. Clonic seizures were correctly identified most frequently (range 36.5-95.6% of observers). Subtle seizures were poorly identified (range 20.4-49.6% of observers). The interobserver agreement (Kappa) for doctors and other health care professionals was poor at 0.21 and 0.29, respectively. Agreement with the correct diagnosis was also poor at 0.09 for doctors and -0.02 for other healthcare professionals.
It is often impossible to accurately differentiate between seizure-related and nonseizure movements in infants using clinical evaluation alone. In addition, doctors do not have a higher capacity for discriminating between neonatal paroxysmal events than other health care professionals. Until reliable continuous neurologic monitoring of newborn babies is available, it is likely that some babies with seizures will remain undetected and others with nonseizure movements will continue to be treated with potentially harmful anticonvulsants.
准确诊断新生儿惊厥至关重要，临床上通常在没有脑电图（EEG）监测的情况下进行诊断。这项观察性研究旨在确定医疗保健专业人员在仅提供临床病史和数字视频记录时，区分临床表现的惊厥与其他新生儿动作的准确性和观察者间的可靠性。
从视频脑电图数据库中选取20段足月儿和早产儿阵发性动作的数字视频记录。使用脑电图将这些动作分类为惊厥和非惊厥。向来自8个新生儿重症监护病房（NICU）的137名医疗保健专业人员展示视频记录以及其他相关临床数据，但不包括脑电图结果。要求观察者指出他们认为哪些动作是惊厥或非惊厥。使用多评分者Kappa统计量来评估观察者之间以及与真实诊断之间的一致性。
91名医生和46名其他专业人员对20个视频片段（11个惊厥，9个非惊厥）进行了评估。正确识别事件的平均数量为10/20。阵挛性惊厥被正确识别的频率最高（观察者识别率范围为36.5% - 95.6%）。细微惊厥的识别率较低（观察者识别率范围为20.4% - 49.6%）。医生和其他医疗保健专业人员的观察者间一致性（Kappa）分别较差，为0.21和0.29。医生与正确诊断的一致性也较差，为0.09，其他医疗保健专业人员为 -0.02。
仅通过临床评估往往无法准确区分婴儿的惊厥相关动作和非惊厥动作。此外，医生在区分新生儿阵发性事件方面并不比其他医疗保健专业人员有更高的能力。在可靠的新生儿连续神经监测可用之前，可能会有一些惊厥婴儿未被发现，而其他有非惊厥动作的婴儿将继续接受可能有害的抗惊厥药物治疗。
