Objective: To evaluate the prognostic value of somatosensory evoked potentials (SEPs) in severe traumatic brain injury (TBI) considering both ‘awakening’and disability. Methods: SEPs were recorded in 60 severe TBI w...Objective: To evaluate the prognostic value of somatosensory evoked potentials (SEPs) in severe traumatic brain injury (TBI) considering both ‘awakening’and disability. Methods: SEPs were recorded in 60 severe TBI with duration of acute coma > 7 days. N20-P25 amplitudes, their side-to-side asymmetry and CCT were measured. SEPs on each hemisphere were classified as normal (N), pathological ( P) or absent (A). ‘Awakening’and disability were assessed after at least 12 mo nths using Glasgow Outcome Scale (GOS). SEP predictive value was compared with G CS and EEG reactivity. Results: Seventy-five percent regained consciousness. 29 /60 had a good outcome (GOS 4-5) and 31/60 had a bad outcome (GOS 1-3). Accord ing to the ROC curve, SEP findings were classified in 3 grades. Grade I (NN, NP) had PPV of 93.1%for ‘awakening’and 86.2%for good outcome. Grade III (AA) ha d PPV of 100%for bad outcome and 72.7%for ‘awakening’. Grade II (PP, NA, PA) was associated with the wider range of outcome. A multivariate analysis includi ng SEP grading, GCS and EEG reactivity did not increase the percentage of cases prognosticated by SEP alone. Conclusions: We confirm the high predictive value o f SEPs in TBI, which is greater than GCS and EEG reactivity.Indeed, SEP grades I and III were able to predict the correct prognosis in more than 80%of severe T BI. Therefore, SEPs should be used more widely in the prognosis of severe TBI.Si gnificance: Differently from post-anoxic, in post-traumaticcoma the presence o f normal SEPs has a favourable predictive value both for ‘awakening’and disabi lity. We think that in literature enough attention has still not been paid to th is finding.展开更多
文摘Objective: To evaluate the prognostic value of somatosensory evoked potentials (SEPs) in severe traumatic brain injury (TBI) considering both ‘awakening’and disability. Methods: SEPs were recorded in 60 severe TBI with duration of acute coma > 7 days. N20-P25 amplitudes, their side-to-side asymmetry and CCT were measured. SEPs on each hemisphere were classified as normal (N), pathological ( P) or absent (A). ‘Awakening’and disability were assessed after at least 12 mo nths using Glasgow Outcome Scale (GOS). SEP predictive value was compared with G CS and EEG reactivity. Results: Seventy-five percent regained consciousness. 29 /60 had a good outcome (GOS 4-5) and 31/60 had a bad outcome (GOS 1-3). Accord ing to the ROC curve, SEP findings were classified in 3 grades. Grade I (NN, NP) had PPV of 93.1%for ‘awakening’and 86.2%for good outcome. Grade III (AA) ha d PPV of 100%for bad outcome and 72.7%for ‘awakening’. Grade II (PP, NA, PA) was associated with the wider range of outcome. A multivariate analysis includi ng SEP grading, GCS and EEG reactivity did not increase the percentage of cases prognosticated by SEP alone. Conclusions: We confirm the high predictive value o f SEPs in TBI, which is greater than GCS and EEG reactivity.Indeed, SEP grades I and III were able to predict the correct prognosis in more than 80%of severe T BI. Therefore, SEPs should be used more widely in the prognosis of severe TBI.Si gnificance: Differently from post-anoxic, in post-traumaticcoma the presence o f normal SEPs has a favourable predictive value both for ‘awakening’and disabi lity. We think that in literature enough attention has still not been paid to th is finding.
