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The difficulty of diagnosing NCSE in clinical practice; external validation of the Salzburg criteria
Author(s) -
Goselink Rianne J. M.,
van Dillen Jeroen J.,
Aerts Marjolein,
Arends Johan,
van Asch Charlotte,
van der Linden Inge,
Pasman Jaco,
Saris Christiaan G. J.,
Zwarts Machiel,
Alfen Nens
Publication year - 2019
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.16289
Subject(s) - electroencephalography , status epilepticus , predictive value , inter rater reliability , positive predicative value , medicine , retrospective cohort study , diagnostic accuracy , cohort , predictive value of tests , clinical practice , epilepsy , psychology , surgery , radiology , physical therapy , psychiatry , developmental psychology , rating scale
To improve the diagnostic accuracy of electroencephalography ( EEG) criteria for nonconvulsive status epilepticus ( NCSE ), external validation of the recently proposed Salzburg criteria is paramount. We performed an external, retrospective, diagnostic accuracy study of the Salzburg criteria, using EEG recordings from patients with and without a clinical suspicion of having NCSE . Of the 191 EEG recordings, 12 (12%) was classified as an NCSE according to the reference standard. In the validation cohort, sensitivity was 67% and specificity was 89%. The positive predictive value was 47% and the negative predictive value was 95%. Ten patients in the control group (n = 93) were false positive, resulting in a specificity of 89.2%. The interrater agreement between the reference standards and between the scorers of the Salzburg criteria was moderate; disagreement occurred mainly in patients with an epileptic encephalopathy. The Salzburg criteria showed a lower diagnostic accuracy in our external validation study than in the original design, suggesting that they cannot replace the current practice of careful weighing of both clinical and EEG information on an individual basis.