A Trial of Real-Time Electrographic Seizure Detection by Neuro-ICU Nurses Using a Panel of Quantitative EEG Trends

Neurocrit Care. 2019 Oct;31(2):312-320. doi: 10.1007/s12028-019-00673-z.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: EEG; ICU; Non-convulsive seizures; Quantitative EEG; Seizures; qEEG.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Clinical Competence*
  • Critical Care Nursing / education
  • Electroencephalography*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Monitoring, Physiologic*
  • Neurophysiology
  • Neuroscience Nursing / education
  • Nurses*
  • Prospective Studies
  • Seizures / diagnosis*
  • Sensitivity and Specificity
  • Young Adult