Evaluation and prognostication in coma

Chiappa, Keith H.; Hill, Rosamund A.

doi:10.1016/s0013-4694(97)00118-1

Cited by 47 publications

(27 citation statements)

References 74 publications

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“…The role of standard neurophysiological methods used for evaluation and prognostication of coma has been reviewed recently by Chiappa and Hill [1998]. It is quite clear that both the electroencephalogram (EEG) and short-latency evoked potentials (EPs), in particular median nerve somatosensory EPs, provide useful prognostic information in comatose patients and seemingly fulfill the requirement of an objective measurement.…”

Section: Introductionmentioning

confidence: 99%

Coma Outcome Prediction Using Event-Related Potentials: P<sub>3</sub> and Mismatch Negativity

Kane

Butler²,

Simpson

2000

Audiol Neurotol

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The prediction of the outcome from coma is of considerable importance to the patients, their relatives and attendant medical staff, and yet current clinical methods lack sensitivity and specificity. Objective investigations can enhance the accuracy of such predictions and are an important adjuvant when reaching decisions to continue or terminate life support. Of the neurophysiological methods available, electroencephalography and short-latency somatosensory evoked potentials have proved the most useful in the clinical setting. These tests are good predictors of an adverse outcome; however, they tell us only about the ongoing cerebral activity and integrity of the primary somatosensory pathways, respectively. The presence of long-latency event-related potentials has been shown to be a useful predictor of a favourable neurological outcome, and thus their use complements other neurophysiological techniques. Their potential application in clinical practice is reviewed.

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Section: Introductionmentioning

confidence: 99%

Coma Outcome Prediction Using Event-Related Potentials: P<sub>3</sub> and Mismatch Negativity

Kane

Butler²,

Simpson

2000

Audiol Neurotol

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“…[1][2][3][4][5][6] Clinicians have also investigated the use of the electroencephalogram and somatosensory evoked potentials to predict outcome from anoxic coma. 4,[7][8][9] Unfortunately, despite much study, it has remained difficult to predict with certainty those patients who will definitely die.…”

mentioning

confidence: 99%

Quantitative Analysis of the Loss of Distinction Between Gray and White Matter in Comatose Patients After Cardiac Arrest

Torbey

Selim

Knorr

et al. 2000

Stroke

201

130

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Background and Purpose-Anecdotal reports suggest that a loss of distinction between gray (GM) and white matter (WM) as adjudged by CT scan predicts poor outcome in comatose patients after cardiac arrest. To address this, we quantitatively assessed GM and WM intensities at various brain levels in comatose patients after cardiac arrest. Methods-Patients for whom consultation was requested within 24 hours of a cardiac arrest were identified with the use of a computerized database that tracks neurological consultations at our institution. Twenty-five comatose patients were identified for whom complete medical records and CT scans were available for review. Twenty-five consecutive patients for whom a CT scan was interpreted as normal served as controls. Hounsfield units (HUs) were measured in small defined areas obtained from axial images at the levels of the basal ganglia, centrum semiovale, and high convexity area. Results-At each level tested, lower GM intensity and higher WM intensity were noted in comatose patients compared with normal controls. The GM/WM ratio was significantly lower among comatose patients compared with controls (PϽ0.0001, rank sum test). There was essentially no overlap in GM/WM ratios between control and study patients. The difference was greatest at the basal ganglia level. We also observed a marginally significant difference in the GM/WM ratio at the basal ganglia level between those patients who died and those who survived cardiac arrest (Pϭ0.035, 1-tailed t test). Using receiver operating characteristic curve analysis, we determined that a difference in GM/WM ratio of Ͻ1.18 at the basal ganglia level was 100% predictive of death. At the basal ganglia level, none of 12 patients below this threshold survived, whereas the survival rate was 46% among patients in whom the ratio was Ͼ1.18. The empirical risk of death was 21.67 for comatose patients with a value below threshold. Conclusions-The ratio in HUs of GM to WM provides a reproducible measure of the distinction between gray and white matter. A lower GM/WM ratio is observed in comatose patients immediately after cardiac arrest. The basal ganglia level seems to be the most sensitive location on CT for measuring this relationship. Although a GM/WM ratio Ͻ1.18 at this level predicted death in this retrospective study, the difference in this study is not robust enough to recommend that management decisions be dictated by CT results. The results, however, do warrant consideration of a prospective study to determine the reliability of CT scanning in predicting outcome for comatose patients after cardiac arrest. (Stroke.

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“…As a predictor of subject outcome following severe acute closed head injury (ACHI), the auditory brainstem response (ABR) has had signifi cant success both in its own right and in combination with other medical measures [Chatrian et al, 1996;Chiappa and Hill, 1998;Hall, 1986Hall, , 1988Moulton, 1997]. This success is confi rmed by the International Federation of Clinical Neurophysiology committee's inclusion of the ABR in their recommended minimum evoked potential test battery for the assessment of neurological status and prediction of outcome in comatose subjects [Chatrian et al, 1996].…”

Section: Introductionmentioning

confidence: 99%

“…The success of the ABR in this role appears to be due to the following [Chatrian et al, 1996;Chiappa and Hill, 1998;Hall, 1986Hall, , 1988Hall, , 1992Moulton, 1997;Soustiel et al, 1993]:…”

Section: Introductionmentioning

confidence: 99%

Over-Complete Discrete Wavelet Transformation of the Normal Auditory Brainstem Response Improves Prediction of Outcome following Severe Acute Closed Head Injury

Wilson

Chapple²,

Phillips³

et al. 2006

Audiol Neurotol

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Previous research has shown that complex statistical analysis (discriminant function analysis) of a ‘normal’ auditory brainstem response (ABR) result can improve this measure’s ability to predict subject outcome following severe acute closed head injury (ACHI). We hypothesized that adding the ABR’s time-frequency information to such an analysis would improve this predictive value even further. ‘Normal’ ABR results were sampled from 69 severe ACHI subjects (22 of whom died and 47 of whom lived) and their time-frequency information extracted using an over-complete discrete wavelet transformation (OCDWT). A series of logistic regression analyses then showed correct predictions of death and survival as follows: ABR measures only 72 and 89% (respectively), ABR OCDWT measures only 82 and 89% (respectively), and ABR and ABR OCDWT measures combined 86 and 93% (respectively). These results showed that the addition of time-frequency information can improve the ability of the ‘normal’ ABR result to predict outcome following severe ACHI.

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Evaluation and prognostication in coma

Cited by 47 publications

References 74 publications

Coma Outcome Prediction Using Event-Related Potentials: P<sub>3</sub> and Mismatch Negativity

Coma Outcome Prediction Using Event-Related Potentials: P<sub>3</sub> and Mismatch Negativity

Quantitative Analysis of the Loss of Distinction Between Gray and White Matter in Comatose Patients After Cardiac Arrest

Over-Complete Discrete Wavelet Transformation of the Normal Auditory Brainstem Response Improves Prediction of Outcome following Severe Acute Closed Head Injury

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