TY - JOUR
T1 - Generalized periodic discharges and 'triphasic waves'
T2 - A blinded evaluation of inter-rater agreement and clinical significance
AU - for the Critical Care EEG Monitoring Research Consortium (CCEMRC)
AU - Foreman, Brandon
AU - Mahulikar, Advait
AU - Tadi, Prasanna
AU - Claassen, Jan
AU - Szaflarski, Jerzy
AU - Halford, Jonathan J.
AU - Dean, Brian C.
AU - Kaplan, Peter W.
AU - Hirsch, Lawrence J.
AU - LaRoche, Suzette
AU - Alvarez, Vincent
AU - Dombrowski, Keith
AU - Fertig, Evan
AU - Gaspard, Nicolas
AU - Lee Woo, Jong
AU - Sarkis, Rani
AU - Schmitt, Sarah
AU - Brandon Westover, M.
N1 - Funding Information:
The Critical Care EEG Monitoring Research Consortium is supported by the American Epilepsy Society and the Epilepsy Foundation.
Funding Information:
Jerzy Szaflarski receives research support from the NIH, Shor Foundation for Epilepsy Research, the American Epilepsy Society, the Epilepsy Foundation of America, the Food and Drug Adminstration, the State of Alabama, the Department of Defense, the Epilepsy Study Consortium, and the University of Alabama at Birmingham; is on the editorial boards of Journal of Epileptology (Associate Editor), Restorative Neurology and Neuroscience (Associate Editor), Folia Medica Copernicana, Journal of Medical Science and Epilepsy and Behavior; and is a consultant for Sage Pharmaceuticals and Biomedical Systems, Inc. Peter W. Kaplan receives additional support from the Qatar National Research Foundation and reports royalties for books on EEG and Epilepsy from Demos and Wiley Blackwell. Larry Hirsch reports investigator-initiated funding to Yale University from UCB-Pharma, Upsher-Smith, Lundbeck, Eisai, and Sunovion; honoraria from Natus and Neuropace; royalties for books and chapters from UpToDate-Neurology, Medlink-Neurology, and Wiley; and is a consultant advisor for Lundbeck, Upsher-Smith, Neuropace, GSK, and Allergan. Suzette LaRoche reports royalties from Demos Publishing. The remaining authors report no relevant disclosures.
Publisher Copyright:
© 2015 International Federation of Clinical Neurophysiology.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Objectives: Generalized periodic discharges (GPDs) are associated with nonconvulsive seizures. Triphasic waves (TWs), a subtype of GPDs, have been described in relation to metabolic encephalopathy and not felt to be associated with seizures. We sought to establish the consistency of use of this descriptive term and its association with seizures. Methods: 11 experts in continuous EEG monitoring scored 20 cEEG samples containing GPDs using Standardized Critical Care EEG Terminology. In the absence of patient information, the inter-rater agreement (IRA) for EEG descriptors including TWs was assessed along with raters' clinical EEG interpretation and compared with actual patient information. Results: The IRA for 'generalized' and 'periodic' was near-perfect (kappa = 0.81), but fair for 'triphasic' (kappa = 0.33). Patients with TWs were as likely to develop seizures as those without (25% vs 26%, N.S.) and surprisingly, patients with TWs were less likely to have toxic-metabolic encephalopathy than those without TWs (55% vs 79%, p < 0.01). Conclusions: While IRA for the terms "generalized" and "periodic" is high, it is only fair for TWs. EEG interpreted as TWs presents similar risk for seizures as GPDs without triphasic appearance. GPDs are commonly associated with metabolic encephalopathy, but 'triphasic' appearance is not predictive. Significance: Conventional association of 'triphasic waves' with specific clinical conditions may lead to inaccurate EEG interpretation.
AB - Objectives: Generalized periodic discharges (GPDs) are associated with nonconvulsive seizures. Triphasic waves (TWs), a subtype of GPDs, have been described in relation to metabolic encephalopathy and not felt to be associated with seizures. We sought to establish the consistency of use of this descriptive term and its association with seizures. Methods: 11 experts in continuous EEG monitoring scored 20 cEEG samples containing GPDs using Standardized Critical Care EEG Terminology. In the absence of patient information, the inter-rater agreement (IRA) for EEG descriptors including TWs was assessed along with raters' clinical EEG interpretation and compared with actual patient information. Results: The IRA for 'generalized' and 'periodic' was near-perfect (kappa = 0.81), but fair for 'triphasic' (kappa = 0.33). Patients with TWs were as likely to develop seizures as those without (25% vs 26%, N.S.) and surprisingly, patients with TWs were less likely to have toxic-metabolic encephalopathy than those without TWs (55% vs 79%, p < 0.01). Conclusions: While IRA for the terms "generalized" and "periodic" is high, it is only fair for TWs. EEG interpreted as TWs presents similar risk for seizures as GPDs without triphasic appearance. GPDs are commonly associated with metabolic encephalopathy, but 'triphasic' appearance is not predictive. Significance: Conventional association of 'triphasic waves' with specific clinical conditions may lead to inaccurate EEG interpretation.
KW - Critical care
KW - EEG monitoring
KW - Inter-rater agreement
KW - Periodic discharges
KW - Seizures
KW - Triphasic waves
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U2 - 10.1016/j.clinph.2015.07.018
DO - 10.1016/j.clinph.2015.07.018
M3 - Article
C2 - 26294138
AN - SCOPUS:84957944955
VL - 127
SP - 1073
EP - 1080
JO - Electroencephalography and Clinical Neurophysiology - Electromyography and Motor Control
JF - Electroencephalography and Clinical Neurophysiology - Electromyography and Motor Control
SN - 1388-2457
IS - 2
ER -