Reduced electrode arrays for the automated detection of rhythmic and periodic patterns in the intensive care unit: Frequently tried, frequently failed?

•First study that systematically evaluates the effect of automated electrode reduction on pattern detection.•Effect of electrode reduction on pattern detection sensitivity was evaluated by a computer algorithm.•Guidance which reduced EEG array may offer the highest detection results in specific situations.

ObjectiveTo investigate the effect of systematic electrode reduction from a common 10-20 EEG system on pattern detection sensitivity (SEN).MethodsTwo reviewers rated 17130 one-minute segments of 83 prospectively recorded cEEGs according to the ACNS standardized critical care EEG terminology (CCET), including burst suppression patterns (BS) and unequivocal electrographic seizures. Consensus annotations between reviewers were used as a gold standard to determine pattern detection SEN and specificity (SPE) of a computational algorithm (baseline, 19 electrodes). Electrodes were than reduced one by one in four different variations. SENs and SPEs were calculated to determine the most beneficial assembly with respect to the number and location of electrodes.ResultsHigh automated baseline SENs (84.99-93.39%) and SPEs (90.05-95.6%) were achieved for all patterns. Best overall results in detecting BS and CCET patterns were found using the “hairline + vertex” montage. While the “forehead + behind ear” montage showed an advantage in detecting ictal patterns, reaching a 15% drop of SEN with 10 electrodes, all montages could detect BS sufficiently if at least nine electrodes were available.ConclusionFor the first time an automated approach was used to systematically evaluate the effect of electrode reduction on pattern detection SEN in cEEG.SignificancePrediction of the expected detection SEN of specific EEG patterns with reduced EEG montages in ICU patients.