Reliability in the assessment of paediatric somatosensory evoked potentials post cardiac arrest

William M. McDevitt; Laura Quinn; Peter R. Bill; Kevin P. Morris; Barnaby R. Scholefield; Stefano Seri

doi:10.1016/j.clinph.2020.12.016

Reliability in the assessment of paediatric somatosensory evoked potentials post cardiac arrest

William M. McDevitt^*, Laura Quinn, Peter R. Bill, Kevin P. Morris, Barnaby R. Scholefield, Stefano Seri

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: To measure inter- and intra-rater agreement in the interpretation of cortical somatosensory evoked potential (SSEP) components following paediatric cardiac arrest (CA) in multi-professional neurophysiology teams.

Methods: Thirteen professionals blinded to patient outcome interpreted 96 SSEPs in paediatric patients 24-/48-/72-hours following CA. Of these, 34 were duplicates used to assess intra-rater agreement. Consistent interpretations (absent/present/indeterminate) between scientists (who record/identify SSEP components) and neurophysiologists (who provide prognostic SSEP interpretation) were expressed as percentages. Rates of agreement were calculated using Fleiss’ kappa coefficient (K).

Results: Unanimous agreement between professionals was present in 40% (95%CI: 28–54%) of the interpreted SSEPs, with a K value of 0.62 (95%CI: 0.55–0.70) based on average agreement. Agreement was similar between neurophysiologists (K = 0.67; 95%CI: 0.57–0.77) and scientists (K = 0.62; 95%CI: 0.54–0.70) but lower in patients < 2 years old (K = 0.23; 95%CI: 0.14–0.33) and in those with poor outcome (K = 0.21; 95%CI: 0.07–0.35). No SSEP was unanimously interpreted as absent and 92% (95%CI: 89–95%) of duplicate SSEPs were interpreted consistently.

Conclusion: Despite substantial agreement when interpreting prognostic SSEPs, this was significantly lower in children with poor outcome and of younger age.

Significance: Clinicians using SSEPs in the intensive care unit should be aware of the inter-rater variability when interpreting SSEPs as absent.

Original language	English
Pages (from-to)	765-769
Number of pages	5
Journal	Clinical Neurophysiology
Volume	132
Issue number	3
Early online date	19 Jan 2021
DOIs	https://doi.org/10.1016/j.clinph.2020.12.016
Publication status	Published - Mar 2021

Bibliographical note

Funding Information:
We wish to acknowledge all clinicians involved with the children in this study and those within the department of neurophysiology and library services at Birmingham Women's and Children's Trust for pilot data and literature search assistance. This work was supported by a Health Education England funded West Midlands writing grant, delivered by Birmingham Health Partners. We wish to thank Birmingham Health Partners for their support.

Publisher Copyright:
© 2021

Keywords

Inter-rater reliability
Interobserver variation
Intra-rater reliability
Pediatrics
Prognosis
Somatosensory evoked potential

ASJC Scopus subject areas

Clinical Neurology
Neurology
Sensory Systems
Physiology (medical)

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Cite this

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title = "Reliability in the assessment of paediatric somatosensory evoked potentials post cardiac arrest",

abstract = "Objective: To measure inter- and intra-rater agreement in the interpretation of cortical somatosensory evoked potential (SSEP) components following paediatric cardiac arrest (CA) in multi-professional neurophysiology teams. Methods: Thirteen professionals blinded to patient outcome interpreted 96 SSEPs in paediatric patients 24-/48-/72-hours following CA. Of these, 34 were duplicates used to assess intra-rater agreement. Consistent interpretations (absent/present/indeterminate) between scientists (who record/identify SSEP components) and neurophysiologists (who provide prognostic SSEP interpretation) were expressed as percentages. Rates of agreement were calculated using Fleiss{\textquoteright} kappa coefficient (K). Results: Unanimous agreement between professionals was present in 40% (95%CI: 28–54%) of the interpreted SSEPs, with a K value of 0.62 (95%CI: 0.55–0.70) based on average agreement. Agreement was similar between neurophysiologists (K = 0.67; 95%CI: 0.57–0.77) and scientists (K = 0.62; 95%CI: 0.54–0.70) but lower in patients < 2 years old (K = 0.23; 95%CI: 0.14–0.33) and in those with poor outcome (K = 0.21; 95%CI: 0.07–0.35). No SSEP was unanimously interpreted as absent and 92% (95%CI: 89–95%) of duplicate SSEPs were interpreted consistently. Conclusion: Despite substantial agreement when interpreting prognostic SSEPs, this was significantly lower in children with poor outcome and of younger age. Significance: Clinicians using SSEPs in the intensive care unit should be aware of the inter-rater variability when interpreting SSEPs as absent.",

keywords = "Inter-rater reliability, Interobserver variation, Intra-rater reliability, Pediatrics, Prognosis, Somatosensory evoked potential",

author = "McDevitt, {William M.} and Laura Quinn and Bill, {Peter R.} and Morris, {Kevin P.} and Scholefield, {Barnaby R.} and Stefano Seri",

note = "Funding Information: We wish to acknowledge all clinicians involved with the children in this study and those within the department of neurophysiology and library services at Birmingham Women's and Children's Trust for pilot data and literature search assistance. This work was supported by a Health Education England funded West Midlands writing grant, delivered by Birmingham Health Partners. We wish to thank Birmingham Health Partners for their support. Publisher Copyright: {\textcopyright} 2021",

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doi = "10.1016/j.clinph.2020.12.016",

language = "English",

volume = "132",

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T1 - Reliability in the assessment of paediatric somatosensory evoked potentials post cardiac arrest

AU - McDevitt, William M.

AU - Quinn, Laura

AU - Bill, Peter R.

AU - Morris, Kevin P.

AU - Scholefield, Barnaby R.

AU - Seri, Stefano

N1 - Funding Information: We wish to acknowledge all clinicians involved with the children in this study and those within the department of neurophysiology and library services at Birmingham Women's and Children's Trust for pilot data and literature search assistance. This work was supported by a Health Education England funded West Midlands writing grant, delivered by Birmingham Health Partners. We wish to thank Birmingham Health Partners for their support. Publisher Copyright: © 2021

PY - 2021/3

Y1 - 2021/3

N2 - Objective: To measure inter- and intra-rater agreement in the interpretation of cortical somatosensory evoked potential (SSEP) components following paediatric cardiac arrest (CA) in multi-professional neurophysiology teams. Methods: Thirteen professionals blinded to patient outcome interpreted 96 SSEPs in paediatric patients 24-/48-/72-hours following CA. Of these, 34 were duplicates used to assess intra-rater agreement. Consistent interpretations (absent/present/indeterminate) between scientists (who record/identify SSEP components) and neurophysiologists (who provide prognostic SSEP interpretation) were expressed as percentages. Rates of agreement were calculated using Fleiss’ kappa coefficient (K). Results: Unanimous agreement between professionals was present in 40% (95%CI: 28–54%) of the interpreted SSEPs, with a K value of 0.62 (95%CI: 0.55–0.70) based on average agreement. Agreement was similar between neurophysiologists (K = 0.67; 95%CI: 0.57–0.77) and scientists (K = 0.62; 95%CI: 0.54–0.70) but lower in patients < 2 years old (K = 0.23; 95%CI: 0.14–0.33) and in those with poor outcome (K = 0.21; 95%CI: 0.07–0.35). No SSEP was unanimously interpreted as absent and 92% (95%CI: 89–95%) of duplicate SSEPs were interpreted consistently. Conclusion: Despite substantial agreement when interpreting prognostic SSEPs, this was significantly lower in children with poor outcome and of younger age. Significance: Clinicians using SSEPs in the intensive care unit should be aware of the inter-rater variability when interpreting SSEPs as absent.

AB - Objective: To measure inter- and intra-rater agreement in the interpretation of cortical somatosensory evoked potential (SSEP) components following paediatric cardiac arrest (CA) in multi-professional neurophysiology teams. Methods: Thirteen professionals blinded to patient outcome interpreted 96 SSEPs in paediatric patients 24-/48-/72-hours following CA. Of these, 34 were duplicates used to assess intra-rater agreement. Consistent interpretations (absent/present/indeterminate) between scientists (who record/identify SSEP components) and neurophysiologists (who provide prognostic SSEP interpretation) were expressed as percentages. Rates of agreement were calculated using Fleiss’ kappa coefficient (K). Results: Unanimous agreement between professionals was present in 40% (95%CI: 28–54%) of the interpreted SSEPs, with a K value of 0.62 (95%CI: 0.55–0.70) based on average agreement. Agreement was similar between neurophysiologists (K = 0.67; 95%CI: 0.57–0.77) and scientists (K = 0.62; 95%CI: 0.54–0.70) but lower in patients < 2 years old (K = 0.23; 95%CI: 0.14–0.33) and in those with poor outcome (K = 0.21; 95%CI: 0.07–0.35). No SSEP was unanimously interpreted as absent and 92% (95%CI: 89–95%) of duplicate SSEPs were interpreted consistently. Conclusion: Despite substantial agreement when interpreting prognostic SSEPs, this was significantly lower in children with poor outcome and of younger age. Significance: Clinicians using SSEPs in the intensive care unit should be aware of the inter-rater variability when interpreting SSEPs as absent.

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KW - Interobserver variation

KW - Intra-rater reliability

KW - Pediatrics

KW - Prognosis

KW - Somatosensory evoked potential

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Reliability in the assessment of paediatric somatosensory evoked potentials post cardiac arrest

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

Access to Document

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Cite this