多中心脑电图工作人员间运用振幅负荷和癫痫样放电评分评价婴儿癫痫性痉挛综合征结果的一致性研究  

Consistency evaluation of Burden of Amplitudes and Epileptiform Discharges score among electroencephalographers:A multi-center study

作　　者：王文 万林 陈健[1,2] 王宏杰 刘通 程伟科 徐洋 张园 赵燕[1,2] 杨光[1,2] WANG Wen;WAN Lin;CHEN Jian;WANG Hongjie;LIU Tong;CHENG Weike;XU Yang;ZHANG Yuan;ZHAO Yan;YANG Guang(Department of Pediatrics,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Senior Department of Pediatrics,the Seventh Medical Center,Chinese PLA General Hospital,Beijing 100700,China;Department of Pediatrics,Peking University First Hospital,Beijing 100034,China;Department of Pediatrics,Peking University People’s Hospital,Beijing 100044,China;Department of Pediatrics,Chengdu Women's and Children's Central Hospital School of Medicine,University of Electronic Science and Technology of China,Chengdu 610091,Sichuan Province,China;Department of Pediatrics,Xuzhou Children's Hospital,Xuzhou 221002,Jiangsu Province,China)

机构地区：[1]解放军总医院第一医学中心儿科,北京100853 [2]解放军总医院第七医学中心儿科医学部,北京100700 [3]北京大学第一医院儿科,北京100034 [4]北京大学人民医院儿科,北京100044 [5]成都市妇女儿童中心医院儿科,中国成都电子科技大学医学院,四川成都610091 [6]徐州市儿童医院儿科,江苏徐州221002

出　　处：《解放军医学院学报》2024年第11期1115-1119,共5页Academic Journal of Chinese PLA Medical School

基　　金：北京市自然科学基金面上项目(7222187)。

摘　　要：背景婴儿癫痫性痉挛综合征(infantile epileptic spasms syndrome,IESS)预后较差。目前的治疗强调早期控制痉挛发作以及脑电图改善。振幅负荷和癫痫样放电(burden of amplitudes and epileptiform discharges,BASED)评分是一种用于评估IESS患儿脑电图严重程度的量化方式,但目前为止未在国内推广应用。目的评估脑电图工作人员使用BASED评分方法对IESS患儿脑电图结果进行判读的一致性,探讨其在国内应用的可能性。方法选取2022年7月—2023年6月在解放军总医院第一医学中心儿科就诊的IESS患儿脑电图数据。随机选择30份初始评价分值为2~5分的脑电图,经由来自5个不同研究中心的6名脑电图工作人员依据BASED评分规则进行评分。使用Fleiss'Kappa检验统计所有脑电图工作人员在评价时间段和评分分值上的一致性,并进一步分为不同工作年限(高年资:全职从事脑电图专业≥10年;低年资:全职从事脑电图专业>5~<10年),统计上述一致性。结果所有6名脑电图工作人员在评分时间段的选择上一致性较高(Kappa=0.623,P<0.001),高年资组在评分时间段的选择上一致性一般(Kappa=0.544,P<0.001),两低年资组一致性较高(Kappa=0.655,P<0.001)。所有6名脑电图工作人员在具体的BASED评分上一致性较低(Kappa=0.361,P<0.001),高年资组在BASED评分上一致性一般(Kappa=0.420,P<0.001),低年资组在BASED评分上一致性较低(Kappa=0.237,P<0.001)。进一步的结果显示,无论是全部6名评价者之间还是不同年资组内,对于BASED评分为5分的样本表现出更高的一致性,Kappa值分别为0.693、0.772、0.686。结论BASED评分用于IESS评价在我国仍面临挑战,脑电图工作人员间判读结果的不一致性限制了其广泛应用。Background Infantile epileptic spasms syndrome(IESS)has a poor prognosis.Current treatment emphasizes early control of spasm seizures and improvement of the electroencephalogram(EEG).The Burden of Amplitude and Epileptiform Discharges(BASED)scale is a quantitative scoring method used to assess the severity of EEG in children with IESS.However,it has not yet been applied in China.Objective To evaluate the consistency of the BASED score among EEG technicians at several epilepsy centers in China,so as to explore the possibility of its application in China.Methods EEG data from children with IESS who visited the Department of Pediatrics at the First Medical Center of Chinese PLA General Hospital from July 2022 to June 2023 were served as the research subjects.Thirty EEGs,initially evaluated with scores ranging from 2 to 5,were randomly chosen and scored by six EEG technicians from 5 centers according to the BASED scoring rules.Fleiss'kappa test was used to assess the consistency of all EEG technicians in terms of the time frame of assessment and the scoring values.Furthermore,the technicians were divided into different groups based on their years of experience(seniority≥10 years vs junior>5 years,<10 years),and the aforementioned consistency was calculated for these groups.Results All EEG technicians showed a high level of consistency in the selection of the scoring time period(Kappa=0.623,P<0.001).The senior group showed moderate consistency in the selection of the time period(Kappa=0.544,P<0.001),while the junior group showed a high level of consistency in the selection of the scoring time period(Kappa=0.655,P<0.001).However,all EEG technicians showed poor consistency in the specific BASED scores(Kappa=0.361,P<0.001),with the senior group showing moderate consistency(Kappa=0.420,P<0.001)and the junior group showing poor consistency(Kappa=0.237,P<0.001)in the BASED scoring.Further results indicated that,whether among the six evaluators or within the different experience groups,there was better consistency for samp

关 键 词：振幅负荷和痫样放电评分 婴儿癫痫性痉挛综合征 脑电图 一致性评价 

分 类 号：R742.1[医药卫生—神经病学与精神病学]