Evidence map›Paper›PMID 25457454›Full record

ReviewSeizure2015

The standardization debate: A conflation trap in critical care electroencephalography.

Marcus C Ng, Nicolas Gaspard, Andrew J Cole, Daniel B Hoch, Sydney S Cash, Matt Bianchi, Deirdre A O'Rourke, Eric S Rosenthal, Catherine J Chu, M Brandon Westover

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Seizure, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
  4. Performance of Spectrogram-Based Seizure Identification of Adult EEGs by Critical Care Nurses and Neurophysiologists.Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society · 2017
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Marcus C NgSection of Neurology, Department of Internal Medicine, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada. Electronic address: mng2@hsc.mb.ca.
Nicolas GaspardComprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA. Electronic address: nicolas.gaspard@yale.edu.
Andrew J ColeEpilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: ajcole1@mgh.harvard.edu.
Daniel B HochEpilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: dhoch@mgh.harvard.edu.
Sydney S CashEpilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: scash@mgh.harvard.edu.
Matt BianchiEpilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: mtbianchi@mgh.harvard.edu.
Deirdre A O'RourkeEpilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: daorourke@mgh.harvard.edu.
Eric S RosenthalEpilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: erosenthal@mgh.harvard.edu.
Catherine J ChuEpilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: cjchu@mgh.harvard.edu.
M Brandon WestoverEpilepsy Service, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: mwestover@mgh.harvard.edu.

Funding

Pediatric Neurology Physician Scientist Program.K12NS066225 · NINDS · MASSACHUSETTS GENERAL HOSPITAL · PI STALEY, KEVIN J. · 2011 to 2015
$1.6M
NINDS NIH HHS K12 NS066225
6 · The paper itself

Abstract

purposePersistent uncertainty over the clinical significance of various pathological continuous electroencephalography (cEEG) findings in the intensive care unit (ICU) has prompted efforts to standardize ICU cEEG terminology and an ensuing debate. We set out to understand the reasons for, and a satisfactory resolution to, this debate.

methodWe review the positions for and against standardization, and examine their deeper philosophical basis.

resultsWe find that the positions for and against standardization are not fundamentally irreconcilable. Rather, both positions stem from conflating the three cardinal steps in the classic approach to EEG, which we term "description", "interpretation", and "prescription". Using real-world examples we show how this conflation yields muddled clinical reasoning and unproductive debate among electroencephalographers that is translated into confusion among treating clinicians. We propose a middle way that judiciously uses both standardized terminology and clinical reasoning to disentangle these critical steps and apply them in proper sequence.

conclusionThe systematic approach to ICU cEEG findings presented herein not only resolves the standardization debate but also clarifies clinical reasoning by helping electroencephalographers assign appropriate weights to cEEG findings in the face of uncertainty.

Indexed as

Monitoring, PhysiologicCritical CareElectroencephalographyHumansIntensive Care UnitsCritical careElectroencephalographyIntensive careLong-term monitoringNomenclatureStandardization

Identifiers

PMID25457454
PMCPMC4465375

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.