Expert accuracy and inter‐rater agreement of “must‐know” EEG findings for adult and child neurology residents

• Published in: Epileptic disorders Vol. 26; no. 1; pp. 109 - 120
• Main Authors: Nascimento, Fábio A., Katyal, Roohi, Olandoski, Marcia, Gao, Hong, Yap, Samantha, Matthews, Rebecca, Rampp, Stefan, Tatum, William, Strowd, Roy, Beniczky, Sándor
• Format: Journal Article
• Language: English
• Published: Boston, USA Wiley Periodicals, Inc 01.02.2024; Wiley Subscription Services, Inc
• Subjects: Accuracy; Adult; Child; education; EEG; EEG education; Electroencephalography; Humans; inter‐rater agreement; inter‐rater variability; Italy; Neurology; noise; Observer Variation; Italy; noise; education; inter-rater variability; EEG; EEG education; inter-rater agreement
• ISSN: 1294-9361; 1950-6945
• DOI: 10.1002/epd2.20186

Objective We published a list of “must‐know” routine EEG (rEEG) findings for trainees based on expert opinion. Here, we studied the accuracy and inter‐rater agreement (IRA) of these “must‐know” rEEG findings among international experts. Methods A previously validated online rEEG examination was disseminated to EEG experts. It consisted of a survey and 30 multiple‐choice questions predicated on the previously published “must‐know” rEEG findings divided into four domains: normal, abnormal, normal variants, and artifacts. Questions contained de‐identified 10–20‐s epochs of EEG that were considered unequivocal examples by five EEG experts. Results The examination was completed by 258 international EEG experts. Overall mean accuracy and IRA (AC1) were 81% and substantial (0.632), respectively. The domain‐specific mean accuracies and IRA were: 76%, moderate (0.558) (normal); 78%, moderate (0.575) (abnormal); 85%, substantial (0.678) (normal variants); 85%, substantial (0.740) (artifacts). Academic experts had a higher accuracy than private practice experts (82% vs. 77%; p = .035). Country‐specific overall mean accuracies and IRA were: 92%, almost perfect (0.836) (U.S.); 86%, substantial (0.762) (Brazil); 79%, substantial (0.646) (Italy); and 72%, moderate (0.496) (India). In conclusion, collective expert accuracy and IRA of “must‐know” rEEG findings are suboptimal and heterogeneous. Significance We recommend the development and implementation of pragmatic, accessible, country‐specific ways to measure and improve the expert accuracy and IRA.