Sensitivity and specificity of the Salzburg EEG criteria for nonconvulsive status epilepticus

IF 4.4 2区医学 Q1 CLINICAL NEUROLOGY Annals of Clinical and Translational Neurology Pub Date : 2024-08-26 DOI:10.1002/acn3.52184

Line B. Ulvin, Kristian B. Nilsen, Erik Taubøll, Lars Etholm, Kjell Heuser

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Abstract

Objective

The Salzburg EEG criteria for nonconvulsive status epilepticus (NCSE) have been proposed as consensus criteria for NCSE. We aimed to perform an independent study of their diagnostic accuracy.

Methods

A prospective study was carried out at Oslo University Hospital, including all consecutive patients ≥15 years old who were referred for an EEG with an explicit or implicit question of NCSE from February 2020 to February 2022. Two independent EEG readers scored the included EEGs according to the Salzburg criteria and blinded to the clinical data. The reference standard was defined as the clinical diagnosis the patient received based on all available clinical and paraclinical data. Diagnostic accuracy in identifying “certain/possible NCSE” was assessed by calculating sensitivity, specificity, positive predictive value, and negative predictive value with their 95% confidence intervals.

Results

In total, 469 patients/EEGs were included in the study. The prevalence of NCSE according to the reference standard was 11% (n = 53). The criteria showed a sensitivity of 94% (95% CI: 92–96%), a specificity of 77% (95% CI: 73–81%), a positive predictive value of 34% (95% CI: 30–39%), and a negative predictive value of 99% (95% CI: 98–100%). False positives for “certain NCSE” (n = 16) included many serial seizures and stimulus-induced rhythmic and periodic discharges (SIRPIDs), as well as a focal cortical dysplasia. False positives for “possible NCSE” (n = 79) were mainly represented by different encephalopathies and postictality.

Interpretation

The low specificity of the Salzburg criteria calls for refinement before implementation into daily clinical practice.

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非惊厥性癫痫状态的萨尔茨堡脑电图标准的敏感性和特异性。

目的：萨尔茨堡非惊厥性癫痫状态（NCSE）脑电图标准已被提出作为 NCSE 的共识标准。我们旨在对其诊断准确性进行独立研究：我们在奥斯陆大学医院开展了一项前瞻性研究，研究对象包括 2020 年 2 月至 2022 年 2 月期间所有转诊接受脑电图检查并明确或隐含 NCSE 问题的年龄≥15 岁的连续患者。两名独立的脑电图阅读者根据萨尔茨堡标准对纳入的脑电图进行评分，并对临床数据进行盲测。参考标准被定义为根据所有可用的临床和准临床数据对患者做出的临床诊断。通过计算灵敏度、特异性、阳性预测值和阴性预测值及其 95% 置信区间，评估识别 "确定/可能的 NCSE "的诊断准确性：研究共纳入了 469 名患者/EEG。根据参考标准，NCSE 的发病率为 11%（n = 53）。该标准的灵敏度为 94% (95% CI: 92-96%)，特异度为 77% (95% CI: 73-81%)，阳性预测值为 34% (95% CI: 30-39%)，阴性预测值为 99% (95% CI: 98-100%)。某些 NCSE"（n = 16）的假阳性包括许多连续性癫痫发作和刺激诱发的节律性和周期性放电（SIRPID），以及局灶性皮质发育不良。可能的 NCSE "假阳性（n = 79）主要表现为不同的脑病和发作后症状：解释：萨尔茨堡标准的特异性较低，在应用于日常临床实践之前需要对其进行改进。

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来源期刊

Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)

CiteScore

9.10

自引率

1.90%

发文量

218

审稿时长

8 weeks

期刊介绍： Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.