A Structured Framework for Translation of the ACNS Standardized Critical Care EEG Terminology Into Spanish

Abstract

Purpose: The American Clinical Neurophysiology Society (ACNS) Critical Care EEG Terminology provides standardized language for describing electroencephalographic (EEG) patterns in critically ill patients but has not been formally translated into Spanish. We aimed to develop a consensus-based Spanish translation of the ACNS Critical Care EEG Terminology using a multi-phase methodology involving physicians from Spanish-speaking countries. Methods: This qualitative study aimed to establish a standardized Spanish ACNS Critical Care EEG terminology through a three-phase process: Phase 1: Initial iterative translation by 14 Spanish-speaking physicians working in subgroups. Discrepancies were documented for further discussion. Phase 2: Focus groups with specialists practicing in Spanish-speaking countries, guided by qualitative research experts. Sessions explored terminology preferences, implementation challenges, and regional variations. Phase 3: Qualitative analysis and final consensus using a modified Delphi methodology. Ranked choice voting analysis to achieve ≥75% consensus was used and when needed, a two-option runoff determined the final selected term. Results: Forty-five physicians from all Spanish-speaking countries except Nicaragua participated in 10 focus groups to review 25 terms. Seven terms generated two possible Spanish translations, four generated three, five generated four, and nine generated five. A consensus-based Spanish terminology was established, prioritizing semantic fidelity to the ACNS terminology while also accounting for terms already in wide regional use. Examples of final consensus terms included: Generalized Periodic Discharges → Descargas Periódicas Generalizadas (98%, Round 1); Lateralized Rhythmic Delta Activity → Actividad Delta Rítmica Lateralizada (100%, round 1); and Sharp Wave → Onda Aguda (82%, round 1). The outdated term periodic lateralized epileptiform discharges remained widely used because of familiarity among intensivists. Conclusions: This effort provides the first structured Spanish adaptation of the ACNS Critical Care EEG terminology. The resulting lexicon reflects linguistic diversity across regions and supports consistent communication, training, research, and broader adoption of evidence-based continuous EEG practices.