DOI: 10.1002/epd2.20186 ISSN: 1294-9361

Expert accuracy and inter‐rater agreement of “must‐know” EEG findings for adult and child neurology residents

Fábio A. Nascimento, Roohi Katyal, Marcia Olandoski, Hong Gao, Samantha Yap, Rebecca Matthews, Stefan Rampp, William Tatum, Roy Strowd, Sándor Beniczky
  • Neurology (clinical)
  • Neurology
  • General Medicine



We published a list of “must‐know” routine EEG (rEEG) findings for trainees based on expert opinion. Here, we studied the accuracy and inter‐rater agreement (IRA) of these “must‐know” rEEG findings among international experts.


A previously validated online rEEG examination was disseminated to EEG experts. It consisted of a survey and 30 multiple‐choice questions predicated on the previously published “must‐know” rEEG findings divided into four domains: normal, abnormal, normal variants, and artifacts. Questions contained de‐identified 10‐to‐20‐second epochs of EEG that were considered unequivocal examples by five EEG experts.


The examination was completed by 258 international EEG experts. Overall mean accuracy and IRA (AC1) were 81% and substantial (0.632), respectively. Domain‐specific mean accuracies and IRA were: 76%, moderate (0.558) (normal); 78%, moderate (0.575) (abnormal); 85%, substantial (0.678) (normal variants); 85%, substantial (0.740) (artifacts). Academic experts had a higher accuracy than private practice experts (82% vs. 77%; p=0.035). Country‐specific overall mean accuracies and IRA were: 92%, almost perfect (0.836) (U.S.); 86%, substantial (0.762) (Brazil); 79%, substantial (0.646) (Italy); 72%, moderate (0.496) (India). In conclusion, collective expert accuracy and IRA of “must‐know” rEEG findings are suboptimal and heterogeneous.


We recommend development and implementation of pragmatic, accessible, country‐specific ways to measure and improve expert accuracy and IRA.

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