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Electroencephalography Leads Placed by Nontechnologists Using a Template System Produce Signals Equal in Quality to Technologist-Applied, Collodion Disk Leads

Kolls, Brad J.*; Olson, DaiWai M.*; Gallentine, William B.*; Skeen, Mark B.*; Skidmore, Christopher T.; Sinha, Saurabh R.*

Journal of Clinical Neurophysiology: February 2012 - Volume 29 - Issue 1 - p 42–49
doi: 10.1097/WNP.0b013e318246ae76
Original Research

Summary The purpose of this study was to compare the quality of the electroencephalographic (EEG) data obtained with a BraiNet template in a practical use setting, to that obtained with standard 10/20 spaced, technologist-applied, collodion-based disk leads. Pairs of 8-hour blocks of EEG data were prospectively collected from 32 patients with a Glasgow coma score of ≤9 and clinical concern for underlying nonconvulsive status epilepticus over a 6-month period in the Neurocritical Care Unit at the Duke University Medical Center. The studies were initiated with the BraiNet template system applied by critical care nurse practitioners or physicians, followed by standard, collodion leads applied by registered technologists using the 10/20 system of placement. Impedances were measured at the beginning and end of each block recorded and variance in impedance, mean impedance, and the largest differences in impedances found within a given lead set were compared. Physicians experienced in reading EEG performed a masked review of the EEG segments obtained to assess the subjective quality of the recordings obtained with the templates. We found no clinically significant differences in the impedance measures. There was a 3-hour reduction in the time required to initiate EEG recording using the templates (P < 0.001). There was no difference in the overall subjective quality distributions for template-applied versus technologist-applied EEG leads. The templates were also found to be well accepted by the primary users in the intensive care unit. The findings suggest that the EEG data obtained with this approach are comparable with that obtained by registered technologist-applied leads and represents a possible solution to the growing clinical need for continuous EEG recording availability in the critical care setting.

*Department of Medicine, Division of Neurology, Duke University Medical Center, Durham, North Carolina

Department of Neurology, Thomas Jefferson University Hospital, 900 Walnut Street, Suite 200, Philadelphia, Pennsylvania.

Address correspondence and reprint requests to Brad J. Kolls, MD, PhD, DUMC Box 2900, Duke University Medical Center, Durham NC 27710; e-mail: kolls001@mc.duke.edu.

Copyright © 2012 American Clinical Neurophysiology Society