Comprehensive Predictions of Outcome in Closed Head‐Injured Patients

Abstract

A comprehensive diagnostic evaluation was administered to 162 closed head-injured patients within 1 to 21 days (mean, 7.5 days) after injury. Each evaluation consisted of (1) power spectral analyses of electroencephalogram (EEG) recorded from 19 scalp locations referenced to age-matched norms, (2) brainstem auditory evoked potentials, (3) computed tomography (CT)-scan, and (4) Glasgow Coma Score (GCS) at time of admission (GCS-A) and at time of EEG test (GCS-T). Functional outcome at one year following injury was assessed using the Rappaport Disability Rating Scale (DRS), which measures the level of disability in the six diagnostic categories of (1) eye opening, (2) best verbal response, (3) best motor response, (4) self-care ability for feeding, grooming, and toileting, (5) level of cognitive functioning, and (6) employability. The ability of the different diagnostic measures to predict outcome at one year following injury was assessed using stepwise discriminant analyses to identify patients in the extreme outcome categories of complete recovery versus death and multivariate regression analyses to predict patients with intermediate outcome scores. The best combination of predictor variables was EEG and GCS-T, which accounted for 74.6% of the variance in the multivariate regression analysis of intermediate outcome scores and 95.8% discriminant accuracy between good outcome and death. The best single predictors of outcome in both the discriminant analyses and the regression analyses were EEG coherence and phase. A gradient of prognostic strength of diagnostic measures was EEG phase greater than EEG coherence greater than GCS-T greater than CT-scan greater than EEG relative power. The value of EEG coherence and phase in the assessment of diffuse axonal injury was discussed.

Treating Thought Disorders

“…59 qEEG studies have shown discriminant accuracy as high as 95.67% in the detection of mild head injury, 60 and >75.8% accuracy in the prediction of outcome one year after injury. 61 These findings have been confirmed by recent studies. [62][63][64][65] Persons with major depression can be differentiated from normal controls with a specificity of 91.3% and sensitivity of 91.3%.…”

A Review of the Effectiveness of Neuroimaging Modalities for the Detection of Traumatic Brain Injury

“…300,309,314 These observations drove the development of combinations of qEEG findings that are used to generate statistical discriminant functions with which to diagnose TBI and in particular, mTBI. 274,275,[310][311][312][313] Substantial controversy remains regarding the products of these efforts. 269,282,291,314,317 The most widely known of the qEEG discriminant functions was developed by Thatcher and colleagues based on frontal and frontaltemporal coherence increases and phase decreases, decreased anteroposterior power differences, and reduced posterior cortical alpha power, among TBI subjects, compared with the healthy comparison subjects.…”

Neurophysiological correlates of persistent vegetative and minimally conscious states

“…It is proposed that coherence provides an index of the integrity of inter-regional networks and communication between cortical areas, as well as with subcortical structures (e.g., thalamus and basal ganglia) that mediate this connectivity (Davey, Victor, & Schiff, 2000;Nunez, Wingeier, & Silberstein, 2001). Therefore, EEG coherence may serve as a better prognostic indicator for recovery after brain injury than power spectral analysis (Thatcher et al, 1991). Kane and colleagues (1998) found a significant reduction of the mean interhemispheric coherence of the EEG for all regions in comatose patients compared to normal healthy control subjects.…”