Feasibility and agreement of a self-adhesive EEG electrode set versus conventional EEG in postanoxic coma

Abstract

Background: Electrode application for EEG prognostication in postanoxic coma patients is labor-intensive. We studied the usability of a self-adhesive forehead EEG electrode (Bittium BrainStatus™) and compared the accuracy of background classification with conventional EEG. Methods: In 51 postanoxic coma patients, simultaneous monitoring using conventional EEG and a forehead electrode was performed. 5-min EEG fragments were classified according to the ACNS criteria by four experts, based on the conventional montage, the forehead electrode, and a montage based on the standard EEG recording but visualized as the forehead electrode. Results: Forehead electrode recordings were of sufficient quality in 74.1% of fragments. Agreement was moderate for standard EEG versus the forehead electrode (κ: 0.56), and near perfect for conventional EEG versus conventional EEG visualized as the forehead electrode (κ: 0.85). Due to higher noise levels, detection rates of discontinuous and suppressed patterns were reduced. Conclusion: EEG forehead electrode recordings were interpretable in a large proportion of cases. If signal quality is insufficient for assessment, additional standard EEG should be performed to allow definitive assessment. Significance: The use of a self-adhesive forehead electrode set has the potential to substantially reduce EEG technician workload in the ICU and suggests considerable potential benefit as a screening-oriented EEG monitoring strategy in postanoxic coma.