Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges in Coma-Incidence and Interrater Reliability of Continuous EEG after a Standard Stimulation Protocol

A Prospective Study

Khalid Alsherbini, Joao Mc O.Neil Plancher, David M. Ficker, Brandon P. Foreman, Opeolu M. Adeoye, Jun Ying, Michael D. Privitera

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Purpose:Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) are often seen during continuous electroencephalographic (cEEG) monitoring in coma. Given their uncertain clinical significance, our prospective study evaluated incidence of SIRPIDs in comatose patients in the neuroscience intensive care unit (NSICU) who underwent a standard stimulation protocol and defined interreader reliability for cEEG. Methods:Of 146 patients prospectively screened who underwent cEEG during a 6-month period, 53 patients were included and 93 patients were excluded. Our protocol used a sequence of auditory, mild tactile, and painful stimuli tested in a quiet room. Continuous electroencephalogram were then reviewed offline by blinded experts, with interrater agreement assessed by kappa statistic. By Pearson χ2 and Wilcoxon rank-sum tests, we then compared binary and numerical clinical features between those with and without SIRPIDs. Results:Of 53 patients who underwent our protocol, one patient with a corrupt cEEG file was excluded. Traumatic brain injury was the most common diagnosis. Moderate interrater agreement was observed for 66 total stimulations: 20 patients (38.5%) had possible or definite SIRPIDs by minimum one reviewer. For 19 stimulations reviewed by a third reviewer, consensus was reached in 10 cases making the incidence of SIRPIDs 19.3% in our cohort. There was a moderate interrate agreement with kappa of 0.5 (95% confidence interval: 0.1, 0.7). Median intensive care unit stay was 15 days in patients with SIRPIDs versus 6.5 days in those without (P = 0.021). Conclusions:Our prospective study of SIRPIDs in the neuroscience intensive care unit found a 19% incidence by cEEG using a standard stimulation protocol, most often rhythmic delta activity, and showed a moderate interrater agreement.

Original languageEnglish (US)
Pages (from-to)375-380
Number of pages6
JournalJournal of Clinical Neurophysiology
Volume34
Issue number4
DOIs
StatePublished - Jul 1 2017

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Coma
Electroencephalography
Stroke
Prospective Studies
Incidence
Intensive Care Units
Neurosciences
Nonparametric Statistics
Touch
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Physiology
  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges in Coma-Incidence and Interrater Reliability of Continuous EEG after a Standard Stimulation Protocol : A Prospective Study. / Alsherbini, Khalid; Plancher, Joao Mc O.Neil; Ficker, David M.; Foreman, Brandon P.; Adeoye, Opeolu M.; Ying, Jun; Privitera, Michael D.

In: Journal of Clinical Neurophysiology, Vol. 34, No. 4, 01.07.2017, p. 375-380.

Research output: Contribution to journalArticle

Alsherbini, Khalid ; Plancher, Joao Mc O.Neil ; Ficker, David M. ; Foreman, Brandon P. ; Adeoye, Opeolu M. ; Ying, Jun ; Privitera, Michael D. / Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges in Coma-Incidence and Interrater Reliability of Continuous EEG after a Standard Stimulation Protocol : A Prospective Study. In: Journal of Clinical Neurophysiology. 2017 ; Vol. 34, No. 4. pp. 375-380.
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abstract = "Purpose:Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) are often seen during continuous electroencephalographic (cEEG) monitoring in coma. Given their uncertain clinical significance, our prospective study evaluated incidence of SIRPIDs in comatose patients in the neuroscience intensive care unit (NSICU) who underwent a standard stimulation protocol and defined interreader reliability for cEEG. Methods:Of 146 patients prospectively screened who underwent cEEG during a 6-month period, 53 patients were included and 93 patients were excluded. Our protocol used a sequence of auditory, mild tactile, and painful stimuli tested in a quiet room. Continuous electroencephalogram were then reviewed offline by blinded experts, with interrater agreement assessed by kappa statistic. By Pearson χ2 and Wilcoxon rank-sum tests, we then compared binary and numerical clinical features between those with and without SIRPIDs. Results:Of 53 patients who underwent our protocol, one patient with a corrupt cEEG file was excluded. Traumatic brain injury was the most common diagnosis. Moderate interrater agreement was observed for 66 total stimulations: 20 patients (38.5{\%}) had possible or definite SIRPIDs by minimum one reviewer. For 19 stimulations reviewed by a third reviewer, consensus was reached in 10 cases making the incidence of SIRPIDs 19.3{\%} in our cohort. There was a moderate interrate agreement with kappa of 0.5 (95{\%} confidence interval: 0.1, 0.7). Median intensive care unit stay was 15 days in patients with SIRPIDs versus 6.5 days in those without (P = 0.021). Conclusions:Our prospective study of SIRPIDs in the neuroscience intensive care unit found a 19{\%} incidence by cEEG using a standard stimulation protocol, most often rhythmic delta activity, and showed a moderate interrater agreement.",
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T1 - Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges in Coma-Incidence and Interrater Reliability of Continuous EEG after a Standard Stimulation Protocol

T2 - A Prospective Study

AU - Alsherbini, Khalid

AU - Plancher, Joao Mc O.Neil

AU - Ficker, David M.

AU - Foreman, Brandon P.

AU - Adeoye, Opeolu M.

AU - Ying, Jun

AU - Privitera, Michael D.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Purpose:Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) are often seen during continuous electroencephalographic (cEEG) monitoring in coma. Given their uncertain clinical significance, our prospective study evaluated incidence of SIRPIDs in comatose patients in the neuroscience intensive care unit (NSICU) who underwent a standard stimulation protocol and defined interreader reliability for cEEG. Methods:Of 146 patients prospectively screened who underwent cEEG during a 6-month period, 53 patients were included and 93 patients were excluded. Our protocol used a sequence of auditory, mild tactile, and painful stimuli tested in a quiet room. Continuous electroencephalogram were then reviewed offline by blinded experts, with interrater agreement assessed by kappa statistic. By Pearson χ2 and Wilcoxon rank-sum tests, we then compared binary and numerical clinical features between those with and without SIRPIDs. Results:Of 53 patients who underwent our protocol, one patient with a corrupt cEEG file was excluded. Traumatic brain injury was the most common diagnosis. Moderate interrater agreement was observed for 66 total stimulations: 20 patients (38.5%) had possible or definite SIRPIDs by minimum one reviewer. For 19 stimulations reviewed by a third reviewer, consensus was reached in 10 cases making the incidence of SIRPIDs 19.3% in our cohort. There was a moderate interrate agreement with kappa of 0.5 (95% confidence interval: 0.1, 0.7). Median intensive care unit stay was 15 days in patients with SIRPIDs versus 6.5 days in those without (P = 0.021). Conclusions:Our prospective study of SIRPIDs in the neuroscience intensive care unit found a 19% incidence by cEEG using a standard stimulation protocol, most often rhythmic delta activity, and showed a moderate interrater agreement.

AB - Purpose:Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) are often seen during continuous electroencephalographic (cEEG) monitoring in coma. Given their uncertain clinical significance, our prospective study evaluated incidence of SIRPIDs in comatose patients in the neuroscience intensive care unit (NSICU) who underwent a standard stimulation protocol and defined interreader reliability for cEEG. Methods:Of 146 patients prospectively screened who underwent cEEG during a 6-month period, 53 patients were included and 93 patients were excluded. Our protocol used a sequence of auditory, mild tactile, and painful stimuli tested in a quiet room. Continuous electroencephalogram were then reviewed offline by blinded experts, with interrater agreement assessed by kappa statistic. By Pearson χ2 and Wilcoxon rank-sum tests, we then compared binary and numerical clinical features between those with and without SIRPIDs. Results:Of 53 patients who underwent our protocol, one patient with a corrupt cEEG file was excluded. Traumatic brain injury was the most common diagnosis. Moderate interrater agreement was observed for 66 total stimulations: 20 patients (38.5%) had possible or definite SIRPIDs by minimum one reviewer. For 19 stimulations reviewed by a third reviewer, consensus was reached in 10 cases making the incidence of SIRPIDs 19.3% in our cohort. There was a moderate interrate agreement with kappa of 0.5 (95% confidence interval: 0.1, 0.7). Median intensive care unit stay was 15 days in patients with SIRPIDs versus 6.5 days in those without (P = 0.021). Conclusions:Our prospective study of SIRPIDs in the neuroscience intensive care unit found a 19% incidence by cEEG using a standard stimulation protocol, most often rhythmic delta activity, and showed a moderate interrater agreement.

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