Abstract
BackgroundUse of electroencephalography (EEG) is currently recommended by the American Clinical Neurophysiology Society for a wide range of indications, including diagnosis of nonconvulsive status epilepticus and evaluation of unexplained disorders of consciousness. Data interpretation usually occurs by expert personnel (e.g., epileptologists, neurophysiologists), with information relayed to the primary care team. However, data cannot always be read in time-sensitive fashion, leading to potential delays in EEG interpretation and patient management. Multiple training programs have recently been described to enable non-experts to rapidly interpret EEG at the bedside. A comprehensive review of these training programs, including the tools used, outcomes obtained, and potential pitfalls, is currently lacking. Therefore, the optimum training program and implementation strategy remain unknown.MethodsWe will conduct a systematic review of descriptive studies, case series, cohort studies, and randomized controlled trials assessing training programs for EEG interpretation by non-experts. Our primary objective is to comprehensively review educational programs in this domain and report their structure, patterns of implementation, limitations, and trainee feedback. Our secondary objective will be to compare the performance of non-experts for EEG interpretation with a gold standard (e.g., interpretation by a certified electroencephalographers). Studies will be limited to those performed in acute care settings in both adult and pediatric populations (intensive care unit, emergency department, or post-anesthesia care units). Comprehensive search strategies will be developed for MEDLINE, EMBASE, WoS, CINAHL, and CENTRAL to identify studies for review. The gray literature will be scanned for further eligible studies. Two reviewers will independently screen the search results to identify studies for inclusion. A standardized data extraction form will be used to collect important data from each study. If possible, we will attempt to meta-analyze the quantitative data. If heterogeneity between studies is too high, we will present meaningful quantitative comparisons of secondary outcomes as per the synthesis without meta-analysis (SWiM) reporting guidelines.DiscussionWe will aim to summarize the current literature in this domain to understand the structure, patterns, and pitfalls of EEG training programs for non-experts. This review is undertaken with a view to inform future education designs, potentially enabling rapid detection of EEG abnormalities, and timely intervention by the treating physician.PROSPERO registrationSubmitted and undergoing review. Registration ID: CRD42020171208.
Highlights
Use of electroencephalography (EEG) is currently recommended by the American Clinical Neurophysiology Society for a wide range of indications, including diagnosis of nonconvulsive status epilepticus and evaluation of unexplained disorders of consciousness
This review is undertaken with a view to inform future education designs, potentially enabling rapid detection of EEG abnormalities, and timely intervention by the treating physician
As a case in point, a survey of neurophysiologists and neurointensivists across approximately 100 institutions in the USA indicated that only 22% of hospitals had dedicated staff for Continuous Electroencephalography (cEEG) 24/7 [21]
Summary
Design A team of investigators with expertise in critical care EEG, neurocritical care, adult and pediatric neurology, and health information collaborated to develop the research question and study design. Assessment of methodological quality and risk of bias If our search identifies a randomized controlled trial (RCT) deemed eligible for inclusion, its risk of bias will be evaluated by two independent reviewers with the Cochrane Collaboration’s risk of bias tool [14]. Summary reports on the quality of each represented study will be presented in tables in the final manuscript The assessment of both randomized and non-randomized studies will be undertaken independently by two reviewers (ST, WA), with discrepancies resolved after joint article review and discussion. Outcomes Our primary objective is to comprehensively review educational programs for training non-experts to interpret EEG, with a focus on reporting programs’ structure, patterns of implementation, challenges, and trainee experience. Pre-post interventional studies assessing non-expert performance before and after an EEG training program will constitute the first group. Findings will not be overinterpreted and will be presented in the context of the quality of studies informing them. 9) Limitations of the synthesis: Limitations will be described, including those resulting from limited evidence, incompletely reported outcome, or incomplete effect estimates
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