• Duez Christophe Henri Valdemar CHV Research Center for Emergency Medicine, Aarhus University and Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark. Elec, Mads Qvist Ebbesen, Krisztina Benedek, Martin Fabricius, Mary Doreen Atkins, Sandor Beniczky, Troels W Kjaer, Hans Kirkegaard, and Birger Johnsen.
• Research Center for Emergency Medicine, Aarhus University and Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark. Electronic address: Christophe.duez@gmail.com.
• Clin Neurophysiol. 2018 Apr 1; 129 (4): 724-730.

ObjectiveTo assess inter-rater agreement on EEG-reactivity (EEG-R) in comatose patients and compare it with a quantitative method (QEEG-R).MethodsSix 30-s stimulation epochs (noxious, visual and auditory) were performed during EEG on 19 neurosurgical and 11 cardiac arrest patients. Six experts analysed EEGs for reactivity using their habitual methods. QEEG-R was defined as present if ≥2/6 epochs were reactive (stimulation/rest power ratio exceeding noise level). Three-months patient outcome was assessed by the Cerebral Performance Category Score (CPC) dichotomized in good (1-2) or poor (3-5).ResultsAgreement among experts on overall EEG-R varied from 53% to 83% (κ: 0.05-0.64) and reached 100% (κ: 1) between two QEEG-R calculators. For the experts, absence of EEG-R yielded sensitivities for poor outcome between 40-85% and specificities between 20-90%, for QEEG-R sensitivity was 40% (CI: 23-68%) and specificity 100% (CI: 69-100%).ConclusionsThere is a large inter-rater variation among experts on EEG-R assessment in comatose patients. QEEG-R is a promising objective prognostic parameter with low inter-rater variation and a high specificity for prediction of poor outcome.SignificanceClinicians should be cautious when using the traditional, qualitative method, in particular in end-of-life decisions. Implementation of the quantitative method in clinical practice may improve reliability of reactivity assessments.Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

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