Hybrid neonatal EEG seizure detection algorithms achieve the benchmark of visual interpretation of the human expert

Neonatal EEG seizure detection algorithms (NSDAs) have an upper bound of performance related to the agreement between visual interpretation of human experts. No published algorithms have reported performance that has reached this upper bound. In this paper, we combined two recently developed NSDAs in order to improve detection performance. An outlier detection stage was also added to improve robustness in the presence of unseen data. A large database of EEG from 79 term infants labeled by three independent human experts was used to develop and test the sufficiency of the hybrid NSDA. The inter-observer agreement (IOA) between experts was high (κ = 0.757, 95%CI: 0.665-0.836, n=79). The area under the receiver operator characteristic of the NSDA compared to the consensus annotation of the human experts was 0.952 (95%CI: 0.0927-0.971). The IOA of seizure detection between the NSDA and human experts was not significantly less than the IOA among human experts (κ = 0.022, 95%CI: -0.20 to 0.072) and was further improved by increasing the minimum seizure duration from 10s to 30s (κ = -0.002, 95%CI: -0.073 to 0.055). Automated methods of neonatal EEG seizure detection have sufficient accuracy to replace human interpretation, potentially, providing reliable interpretations for clinicians in the neonatal intensive care unit.