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Abstract
Objective To determine whether quantitative EEG (QEEG) features predict neurologic outcomes in children after cardiac arrest.
Methods We performed a single-center prospective observational study of 87 consecutive children resuscitated and admitted to the pediatric intensive care unit after cardiac arrest. Full-array conventional EEG data were obtained as part of clinical management. We computed 8 QEEG features from 5-minute epochs every hour after return of circulation. We developed predictive models utilizing random forest classifiers trained on patient age and 8 QEEG features to predict outcome. The features included SD of each EEG channel, normalized band power in alpha, beta, theta, delta, and gamma wave frequencies, line length, and regularity function scores. We measured outcomes using Pediatric Cerebral Performance Category (PCPC) scores. We evaluated the models using 5-fold cross-validation and 1,000 bootstrap samples.
Results The best performing model had a 5-fold cross-validation accuracy of 0.8 (0.88 area under the receiver operating characteristic curve). It had a positive predictive value of 0.79 and a sensitivity of 0.84 in predicting patients with favorable outcomes (PCPC score of 1–3). It had a negative predictive value of 0.8 and a specificity of 0.75 in predicting patients with unfavorable outcomes (PCPC score of 4–6). The model also identified the relative importance of each feature. Analyses using only frontal electrodes did not differ in prediction performance compared to analyses using all electrodes.
Conclusions QEEG features can standardize EEG interpretation and predict neurologic outcomes in children after cardiac arrest.
Glossary
- AUROC=
- area under the receiver operating characteristic curve;
- CI=
- confidence interval;
- NPV=
- negative predictive value;
- PCPC=
- Pediatric Cerebral Performance Category;
- PPV=
- positive predictive value;
- QEEG=
- quantitative EEG;
- ROC=
- receiver operating characteristic
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work as co–first authors.
- Received October 10, 2018.
- Accepted in final form January 17, 2019.
- © 2019 American Academy of Neurology
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