Inter-rater agreement on identification of electrographic seizures and periodic discharges in ICU EEG recordings

J. J. Halford, D. Shiau, J. A. Desrochers, B. J. Kolls, B. C. Dean, C. G. Waters, N. J. Azar, K. F. Haas, E. Kutluay, G. U. Martz, S. R. Sinha, R. T. Kern, K. M. Kelly, J. C. Sackellares, S. M. LaRoche

    Research output: Contribution to journalArticlepeer-review

    30 Scopus citations


    Objective: This study investigated inter-rater agreement (IRA) among EEG experts for the identification of electrographic seizures and periodic discharges (PDs) in continuous ICU EEG recordings. Methods: Eight board-certified EEG experts independently identified seizures and PDs in thirty 1-h EEG segments which were selected from ICU EEG recordings collected from three medical centers. IRA was compared between seizure and PD identifications, as well as among rater groups that have passed an ICU EEG Certification Test, developed by the Critical Care EEG Monitoring Research Consortium (CCEMRC). Results: Both kappa and event-based IRA statistics showed higher mean values in identification of seizures compared to PDs (k= 0.58 vs. 0.38; p<. 0.001). The group of rater pairs who had both passed the ICU EEG Certification Test had a significantly higher mean IRA in comparison to rater pairs in which neither had passed the test. Conclusions: IRA among experts is significantly higher for identification of electrographic seizures compared to PDs. Additional instruction, such as the training module and certification test developed by the CCEMRC, could enhance this IRA. Significance: This study demonstrates more disagreement in the labeling of PDs in comparison to seizures. This may be improved by education about standard EEG nomenclature.

    Original languageEnglish (US)
    Pages (from-to)1661-1669
    Number of pages9
    JournalClinical Neurophysiology
    Issue number9
    StatePublished - Sep 1 2015


    • Continuous monitoring
    • EEG
    • ICU EEG monitoring
    • Inter-rater agreement
    • Periodic discharge
    • Seizure detection

    ASJC Scopus subject areas

    • Sensory Systems
    • Neurology
    • Clinical Neurology
    • Physiology (medical)


    Dive into the research topics of 'Inter-rater agreement on identification of electrographic seizures and periodic discharges in ICU EEG recordings'. Together they form a unique fingerprint.

    Cite this