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Concerning the 14 & 6 per Second Positive Spike Cases in Post Traumatic Medical-Legal EEGs Reported by Gibbs and Gibbs: A Statistical Commentary

In their report' of a very large series of electroencephalograms secured from ambulatory patients referred as post traumatic medical-legal cases, the Gibbses note that pronounced forms of electroencephalographic abnormality occur only infrequently whereas the 14 &6 per second positive spike pattern is often encountered. Independent of the contribution their report makes to medical-legal electroencephalography in general we became impressed with the relevance of much of their data to the issue of normality versus abnormality of the 14 &6 pattern in particular. We decided to subject portions of the Gibbs' data (which is displayed in frequency or percentage format) to additional statistical evaluation. This resulted in a series of data analyses which lend strong support to the viewpoint that the 14 & 6 positive spike dysrhythmia is abnormal. Table 2 of the Gibbs' report displays the relative incidence of normal EEGs and 14 &6 EEGs as a function of linear, depressed, and basal skull fractures. These authors have already commented on the reverse trends obtained, i.e. 14 &6 incidence increases while normal EEG incidence decreases as one moves from linear to basal fractures. We have re-arranged this material as shown in Table 1. The relative incidences of 14 & 6 and.normal EEGs are displayed across the three fracture categories and column Ns are adjusted to reflect a contrast between only these two EEG findings. Statistical analysis of this data results in a Cochran X2for linear reqression" of 3.95 (d.f.=1, p<.05), indicating that the observed increase in incidence of 14 & 6 is directly and linearly related to increasing severity of fracture and not attributable to chance. In the Gibbs' report Table 4 presents the incidence of normal EEG, 14 & 6 EEG, and focal spiking EEG cross tabulated with three states of consciousness immediately following head trauma. In discussing this table the authors state that the association of 14 & 6 positive spikes with alteration of consciousness is' not strong. Such a conclusion may initially seem warranted by visual inspection of the percentage figures since the 14 & 6 incidence in the dazed and unconscious groups are similar. However, additional analysis shows that the relationship of positive spike incidence to post traumatic state of consciousness is, in fact, highly statistically significant. In Table 2 we have re-arranged the Gibbs' data by collapsing the normal EEG and focal spikes into one non-14 & 6 group to be contrasted with the 14 & 6 incidence across the three levels of post traumatic consciousness state. The Cochran X2 for linear regression obtained (X2=13.12, d.f.=1. p=.0003) indicates that the increase in 14 & 6 incidence as one moves from conscious through dazed to unconscious post traumatic state reaches a high level of statistical significance. The analyses contained in Tables 1 and 2 of this present report indicate that the 14 & 6 dysrhythmia undergoes a variation in incidence as a linear function of both (1) seriousness of fracture and (2) immediate post trauma state of consciousness and that furthermore this variation is highly statistically significant. Therefore at least in this material 14 & 6 spiking seems directly proportional and normal EEGs inversely proportional to two physical parameters related to severity of trauma. This argues for the abnormality of the positive spike pattern. Additional evidence in support of this point of view is gained by analysis ofTable 3 of the Gibbs' report where the incidence of asymptomatic cases among patients with normal