Prospective evaluation of interrater agreement between EEG technologists and neurophysiologists

We aim to prospectively investigate, in a large and heterogeneous population, the electroencephalogram (EEG)-reading performances of EEG technologists. A total of 8 EEG technologists and 5 certified neurophysiologists independently analyzed 20-min EEG recordings. Interrater agreement (IRA) for predefined EEG pattern identification between EEG technologists and neurophysiologits was assessed using percentage of agreement (PA) and Gwet-AC1. Among 1528 EEG recordings, the PA [95% confidence interval] and interrater agreement (IRA, AC1) values were as follows: status epilepticus (SE) and seizures, 97% [96-98%], AC1 kappa=0.97; interictal epileptiform discharges, 78% [76-80%], AC1=0.63; and conclusion dichotomized as normal versus pathological, 83.6% [82-86%], AC1=0.71. EEG technologists identified SE and seizures with 99% [98-99%] negative predictive value, whereas the positive predictive values (PPVs) were 48% [34-62%] and 35% [20-53%], respectively. The PPV for normal EEGs was 72% [68-76%]. SE and seizure detection were impaired in poorly cooperating patients (SE and seizures; p<0.001), intubated and older patients (SE; p<0.001), and confirmed epilepsy patients (seizures; p=0.004). EEG technologists identified ictal features with few false negatives but high false positives, and identified normal EEGs with good PPV. The absence of ictal features reported by EEG technologists can be reassuring; however, EEG traces should be reviewed by neurophysiologists before taking action.

Automated summary

This study aimed to investigate the EEG-reading performances of EEG technologists in a large and diverse population. The results showed high agreement between EEG technologists and neurophysiologists in identifying normal and pathological EEG patterns, but higher false positives in detecting seizures and status epilepticus. The study also found that the ability of EEG technologists to detect seizures and status epilepticus was impaired in certain patient populations, such as uncooperative or confirmed epilepsy patients.