Objective To assess whether Somatosensory Evoked Potentials (SEPs), recorded within 24 h after ICU admission, are reliable predictors of brain death (BD) in comatose patients with acquired brain injury of various aetiologies. Methods SEPs were classified as absent (A), pathological (P), and normal (N). Considering SEP recordings from both hemispheres, 6 patterns were identified: NN, NP, PP, NA, AP, and AA. The final endpoint was BD. Results Of the 203 patients included in the study, 70 (34%) evolved toward BD. The survival analysis indicated that the combination of SEP patterns in a two-graded scale (grade 1: NN-NP-PP-NA, and grade 2: AP-AA), allowed for prediction of BD with the best accuracy. This aggregation predicted BD with a sensitivity of 75.7% (CI: 64–84), a specificity of 76.6% (CI: 68–83), a positive predictive value of 64.2% (CI: 53–74) and a negative predictive value of 84.3% (CI: 77–90) in overall patients, and with a sensitivity of 75.0% (CI: 63–84), a specificity of 84.9% (CI: 75–90), a positive predictive value of 77.5% (CI: 63–88) and a negative predictive value of 84.3% (CI: 74–91) when excluding cardiac arrest. Conclusion It is worth including SEPs, in association with other investigations and clinical signs, in prognostic scores of BD. The early identification of patients at high risk of evolving towards BD could help physicians to optimise management.

Predictive patterns of sensory evoked potentials in comatose brain injured patients evolving to brain death / Francesco, Lolli. - In: NEUROPHYSIOLOGIE CLINIQUE-CLINICAL NEUROPHYSIOLOGY. - ISSN 0987-7053. - STAMPA. - 47:(2017), pp. 19-29.

Predictive patterns of sensory evoked potentials in comatose brain injured patients evolving to brain death

LOLLI, FRANCESCO
2017

Abstract

Objective To assess whether Somatosensory Evoked Potentials (SEPs), recorded within 24 h after ICU admission, are reliable predictors of brain death (BD) in comatose patients with acquired brain injury of various aetiologies. Methods SEPs were classified as absent (A), pathological (P), and normal (N). Considering SEP recordings from both hemispheres, 6 patterns were identified: NN, NP, PP, NA, AP, and AA. The final endpoint was BD. Results Of the 203 patients included in the study, 70 (34%) evolved toward BD. The survival analysis indicated that the combination of SEP patterns in a two-graded scale (grade 1: NN-NP-PP-NA, and grade 2: AP-AA), allowed for prediction of BD with the best accuracy. This aggregation predicted BD with a sensitivity of 75.7% (CI: 64–84), a specificity of 76.6% (CI: 68–83), a positive predictive value of 64.2% (CI: 53–74) and a negative predictive value of 84.3% (CI: 77–90) in overall patients, and with a sensitivity of 75.0% (CI: 63–84), a specificity of 84.9% (CI: 75–90), a positive predictive value of 77.5% (CI: 63–88) and a negative predictive value of 84.3% (CI: 74–91) when excluding cardiac arrest. Conclusion It is worth including SEPs, in association with other investigations and clinical signs, in prognostic scores of BD. The early identification of patients at high risk of evolving towards BD could help physicians to optimise management.
2017
47
19
29
Francesco, Lolli
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Utilizza questo identificatore per citare o creare un link a questa risorsa: https://hdl.handle.net/2158/1063731
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