The maximum value of bispectral index predicts outcome in hypoxic-ischemic encephalopathy after resuscitation, better than minimum or mean value

Miao, Wen-li; Sun, Qing; Wang, Hongdao; Li, Hailing

doi:10.1080/02699052.2018.1476732

Cited by 3 publications

(11 citation statements)

References 32 publications

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“…Over the past decade, BIS has also been evaluated as an early prognostic tool for neurological outcomes in patients achieving ROSC after CA. However, the optimal cutoff value of BIS to predict poor neurological outcomes has not been determined and has ranged from 5 to 71.5 in previous studies [29,31]. As a result, it remains challenging for physicians to apply BIS to predict neurological outcomes in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…Thirteen studies with a total of 999 patients were included. Among them, 10 are prospective studies [25][26][27][28][29][30][31][32][33][34], 2 are retrospective [35,36], and the study design was not mentioned in 1 study [37]. Three of them were conference abstracts with sufficient information for analysis [31,32,35].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three of them were conference abstracts with sufficient information for analysis [31,32,35]. Seven studies were conducted in Europe [25,28,[31][32][33][34]37], two in North America [26,30], and four in Asia [27,29,35,36]. Three studies included only OHCA patients [25,27,28], while the rest included all CA patients.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three studies included only OHCA patients [25,27,28], while the rest included all CA patients. Most of the studies adopted TTM after ROSC except for two studies [29,31]. Only some of the patients had TTM in the Selig et al study [37].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In studies where the data were originally reported as predicting good neurological outcomes (CPC 1-2) [27,30], we manually reconstructed the data into a 2 × 2 table predicting the poor neurological outcomes (CPC 3-5). In studies where the data were originally reported as predicting survival [29,30], we regarded them as predicting neurological outcomes of CPC 1-4, and then manually reconstructed the data into a 2 × 2 table predicting the neurological outcome of CPC 5. The timing when the prognosis assessment was performed varied across studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

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The Effects of Early Bispectral Index to Predict Poor Neurological Function in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

et al. 2020

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The diagnostic performance of the bispectral index (BIS) to early predict neurological outcomes in patients achieving return of spontaneous circulation (ROSC) after cardiac arrest (CA) remained unclear. We searched PubMed, EMBASE, Scopus and CENTRAL for relevant studies through October 2019. Methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Meta-analysis was performed using a linear mixed-effects model to the log-transformed data with a logistic distribution assumption. Bivariate meta-regression was performed to explore heterogeneity. In total, 13 studies with 999 CA adult patients were included. At the optimal threshold of 32, BIS obtained within 72 h of ROSC elicits a pooled sensitivity of 84.9% (95% confidence interval (CI), 71.1% to 92.7%), a pooled specificity of 85.9% (95% CI, 71.2% to 93.8%) and an area under the curve of 0.92. Moreover, a BIS cutoff < 12 yielded a pooled specificity of 95.0% (95% CI, 77.8% to 99.0%). In bivariate meta-regression, the timing of neurological outcome assessment, the adoption of targeted temperature management, and the administration of sedative agents or neuromuscular blocking agents (NMBA) were not identified as the potential source of heterogeneity. BIS retains good diagnostic performance during targeted temperature management (TTM) and in the presence of administrated sedative agents and NMBA. In conclusion, BIS can predict poor neurological outcomes early in patients with ROSC after CA with good diagnostic performance and should be incorporated into the neuroprognostication strategy algorithm.

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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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The Effects of Early Bispectral Index to Predict Poor Neurological Function in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

et al. 2020

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Evaluation of Prognosis of Coma Patients With Acute Brain Injury by Electroencephalogram Bispectral Index Monitoring

Shi

Shen

et al. 2021

Journal of Trauma Nursing

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Background: The high mortality rate of comatose patients with traumatic brain injury is a prominent public health issue that negatively impacts patients and their families. Objective, reliable tools are needed to guide treatment decisions and prioritize resources. Objective: This study aimed to evaluate the prognostic value of the bispectral index (BIS) in comatose patients with severe brain injury. Methods: This was a retrospective cohort study of 84 patients with severe brain injury and Glasgow Coma Scale (GCS) scores of 8 and less treated from January 2015 to June 2017. Sedatives were withheld at least 24 hr before BIS scoring. The BIS value, GCS scores, and Full Outline of UnResponsiveness (FOUR) were monitored hourly for 48 hr. Based on the Glasgow Outcome Scale (GOS) score, the patients were divided into poor (GOS score: 1–2) and good prognosis groups (GOS score: 3–5). The correlation between BIS and prognosis was analyzed by logistic regression, and the receiver operating characteristic curves were plotted. Results: The mean (SD) of the BIS value: 54.63 (11.76), p = .000; and GCS score: 5.76 (1.87), p = .000, were higher in the good prognosis group than in the poor prognosis group. Lower BIS values and GCS scores were correlated with poorer prognosis. Based on the area under the curve of receiver operating characteristic curves, the optimal diagnostic cutoff value of the BIS was 43.6, and the associated sensitivity and specificity were 85.4% and 74.4%, respectively. Conclusion: Taken together, our study indicates that BIS had good predictive value on prognosis. These findings suggested that BIS could be used to evaluate the severity and prognosis of severe brain injury.

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Bispectral Index in predicting in‐hospital mortality in patients with ischemic stroke: A methodological study

Gür

Akbaş

Kose

et al. 2022

Hong Kong j. emerg. med.

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Background: Ischemic stroke is a leading cause of death and functional disability worldwide. Several clinical scores or stroke scales, biological test or markers, clinical signs, and radiological imaging have been performed to predict both worse neurologic outcome and mortality for ischemic stroke. Objectives: The aim of our study was to investigate the association between early Bispectral Index scores and in-hospital mortality in patients with ischemic stroke. Methods: This is a comparative prospective methodological study, in which we evaluated the predictive accuracies of Bispectral Index, Glasgow Coma Scale, and Charlson Comorbidity Index for in-hospital mortality of patients with ischemic stroke. Receiver operating characteristic analysis was used for comparing the accuracy of the scoring systems, areas under receiver operating characteristic curves were calculated, and Youden J index was used for estimating associated cut-off values. Results: Among the 80 ischemic stroke patients, in-hospital mortality rate was 38.8% (n = 31). The areas under receiver operating characteristic curves were 0.984, 0.960, and 0.863 for Bispectral Index, Glasgow Coma Scale, and Charlson Comorbidity Index, respectively. The difference between areas under receiver operating characteristic curves for Bispectral Index and Glasgow Coma Scale was statistically similar. Besides, the difference between areas under receiver operating characteristic curves for Bispectral Index and Charlson Comorbidity Index, and the difference between areas under receiver operating characteristic curves for Glasgow Coma Scale and Charlson Comorbidity Index were statistically significant. The associated cut-off values were ⩽74, ⩽12, and >4 for Bispectral Index, Glasgow Coma Scale, and Charlson Comorbidity Index, respectively. For these cut-off points, sensitivity and specificity of Bispectral Index were 93.6% and 95.9%, sensitivity and specificity of Glasgow Coma Scale were 100.0% and 83.7%, and sensitivity and specificity of Charlson Comorbidity Index were 83.9% and 69.4%, respectively. However, accuracy of Bispectral Index was 95.0%, accuracy of Glasgow Coma Scale was 90.0%, and accuracy of Charlson Comorbidity Index was 75.0. Conclusion: Knowledge of the risk factors for mortality in patients with ischemic stroke can help to identify which patients have a higher risk of fatal outcome. The Bispectral Index score improved discrimination and classified patients with higher mortality better than both Glasgow Coma Scale and Charlson Comorbidity Index.

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The maximum value of bispectral index predicts outcome in hypoxic-ischemic encephalopathy after resuscitation, better than minimum or mean value

Abstract: The BIS is a better outcome predictor than BIS or BIS for patients with HIE after resuscitation. Lower BIS represents higher risk of mortality. Additionally, BIS value decreases to zero represents a poor outcome.

Cited by 3 publications

References 32 publications

The Effects of Early Bispectral Index to Predict Poor Neurological Function in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

The Effects of Early Bispectral Index to Predict Poor Neurological Function in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

Evaluation of Prognosis of Coma Patients With Acute Brain Injury by Electroencephalogram Bispectral Index Monitoring

Bispectral Index in predicting in‐hospital mortality in patients with ischemic stroke: A methodological study

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