Hypsarrhythmia assessment exhibits poor interrater reliability: A threat to clinical trial validity

Hypsarrhythmia is the classic interictal electroencephalographic pattern associated with infantile spasms, and characterized by high voltage, disorganization, and multifocal independent epileptiform discharges. Given this seemingly simple definition, one might expect excellent interrater reliability (IRR) in the identification of this pattern. Alternatively, it may be argued that assessments of voltage and disorganization are fairly subjective, and thus quite challenging in borderline cases. We sought to test the IRR of hypsarrhythmia assessment in a systematic fashion.

[1]  E. Berner,et al.  Overconfidence as a cause of diagnostic error in medicine. , 2008, The American journal of medicine.

[2]  Shlomo Shinnar,et al.  Infantile spasms: A U.S. consensus report , 2010, Epilepsia.

[3]  C. Binnie,et al.  Glossar der meistgebrauchten Begriffe in der klinischen Elektroenzephalographie und Vorschläge für die EEG-Befunderstellung , 2004 .

[4]  Arthur C. Grant,et al.  EEG interpretation reliability and interpreter confidence: A large single-center study , 2014, Epilepsy & Behavior.

[5]  F. Gibbs,et al.  Atlas of electroencephalography , 1941 .

[6]  J. Osborne,et al.  A Proposal for Case Definitions and Outcome Measures in Studies of Infantile Spasms and West Syndrome: Consensus Statement of the West Delphi Group , 2004, Epilepsia.

[7]  Justus J. Randolph Free-Marginal Multirater Kappa (multirater K[free]): An Alternative to Fleiss' Fixed-Marginal Multirater Kappa. , 2005 .

[8]  M. Mikati,et al.  Hypsarrhythmia: Frequency of Variant Patterns and Correlation with Etiology and Outcome , 1997, Neurology.

[9]  J D Frost,et al.  Hypsarrhythmia: Variations on the Theme , 1984, Epilepsia.

[10]  E. Mizrahi,et al.  Pretreatment EEG in childhood absence epilepsy , 2013, Neurology.

[11]  Matthijs J. Warrens,et al.  Inequalities between multi-rater kappas , 2010, Adv. Data Anal. Classif..

[12]  J. Mytinger,et al.  The Current Evaluation and Treatment of Infantile Spasms Among Members of the Child Neurology Society , 2012, Journal of child neurology.

[13]  W. Shields Infantile Spasms: Little Seizures, BIG Consequences , 2006, Epilepsy currents.