Department of Neurology, Duke University Medical Center, DUMC 2905, Durham, NC, 27710, USA.
Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, NC, USA.
Neurocrit Care. 2019 Oct;31(2):312-320. doi: 10.1007/s12028-019-00673-z.
Non-convulsive seizures (NCS) are a common occurrence in the neurologic intensive care unit (Neuro-ICU) and are associated with worse outcomes. Continuous electroencephalogram (cEEG) monitoring is necessary for the detection of NCS; however, delays in interpretation are a barrier to early treatment. Quantitative EEG (qEEG) calculates a time-compressed simplified visual display from raw EEG data. This study aims to evaluate the performance of Neuro-ICU nurses utilizing bedside, real-time qEEG interpretation for detecting recurrent NCS.
This is a prospective, single-institution study of patients admitted to the Duke Neuro-ICU between 2016 and 2018 who had NCS identified on traditional cEEG review. The accuracy of recurrent seizure detection on hourly qEEG review by bedside Neuro-ICU nurses was compared to the gold standard of cEEG interpretation by two board-certified neurophysiologists. The nurses first received brief qEEG training, individualized for their specific patient. The bedside qEEG display consisted of rhythmicity spectrogram (left and right hemispheres) and amplitude-integrated EEG (left and right hemispheres) in 1-h epochs.
Twenty patients were included and 174 1-h qEEG blocks were analyzed. Forty-seven blocks contained seizures (27%). The sensitivity was 85.1% (95% CI 71.1-93.1%), and the specificity was 89.8% (82.8-94.2%) for the detection of seizures for each 1-h block when compared to interpretation of conventional cEEG by two neurophysiologists. The false positive rate was 0.1/h. Hemispheric seizures (> 4 unilateral EEG electrodes) were more likely to be correctly identified by nurses on qEEG than focal seizures (≤ 4 unilateral electrodes) (p = 0.03).
After tailored training sessions, Neuro-ICU nurses demonstrated a good sensitivity for the interpretation of bedside real-time qEEG for the detection of recurrent NCS with a low false positive rate. qEEG is a promising tool that may be used by non-neurophysiologists and may lead to earlier detection of NCS.
非惊厥性发作（NCS）在神经重症监护病房（Neuro-ICU）中很常见，与更差的预后相关。连续脑电图（cEEG）监测对于 NCS 的检测是必要的；然而，解释的延迟是早期治疗的障碍。定量脑电图（qEEG）从原始 EEG 数据计算时间压缩的简化视觉显示。本研究旨在评估神经重症监护病房护士利用床边实时 qEEG 解释来检测复发性 NCS 的性能。
这是一项前瞻性的单中心研究，纳入了 2016 年至 2018 年期间入住杜克神经重症监护病房的患者，这些患者在传统 cEEG 回顾中发现了 NCS。床边神经重症监护病房护士在每小时 qEEG 复查中对复发性癫痫发作的检测准确性与两名 board-certified 神经生理学家的 cEEG 解释金标准进行了比较。护士首先接受了针对特定患者的简短 qEEG 培训。床边 qEEG 显示包括节律性频谱图（左右半球）和振幅整合脑电图（左右半球）的 1 小时时程。
共纳入 20 例患者，分析了 174 个 1 小时 qEEG 块。47 个块包含发作（27%）。与两名神经生理学家对传统 cEEG 的解释相比，每 1 小时块检测发作的敏感性为 85.1%（95%CI 71.1-93.1%），特异性为 89.8%（82.8-94.2%）。假阳性率为 0.1/h。与局灶性发作（≤4 个单侧 EEG 电极）相比，半球性发作（>4 个单侧 EEG 电极）更有可能被护士在 qEEG 上正确识别（p=0.03）。
经过定制的培训课程，神经重症监护病房护士在解释床边实时 qEEG 以检测复发性 NCS 方面表现出良好的敏感性，假阳性率低。qEEG 是一种很有前途的工具，非神经生理学家也可以使用，并可能导致更早地检测到 NCS。
