Highlights
- •Middle-latency evoked potentials predict the outcomes of comatose patients.
- •Middle-latency somatosensory evoked potential (MLSEP) improves outcome prediction.
- •MLSEP is valuable when used within the first week after ischemic brain injuries.
Abstract
Objective
To explore the role of middle latency evoked potentials (EPs) as predictors for favorable
outcome in patients with severe ischemic brain injuries by comparing the prognostic
ability of short latency somatosensory and auditory evoked potentials (SLSEP and BAEP)
with middle latency somatosensory and auditory evoked potentials (MLSEP and MLAEP).
Methods
MLSEP, MLAEP, SLSEP and BAEP were recorded in 112 patients with severe ischemic brain
injuries (Glasgow Coma Scale ≤ 8). Among them, 83 patients suffered from cerebral ischemic stroke and 29 suffered
from anoxic–ischemic encephalopathy after cardiopulmonary resuscitation between 1
and 7 days after the onset of stroke. Outcomes were reviewed 6 months later using the Glasgow Outcome Scale (GOS). A GOS score of 4–5 was considered
as a good outcome while a score of 1–3 was considered as poor.
Results
By using the prognostic authenticity analysis of predictors for good outcome, at least
unilateral N20 of the SLSEP exit and at least unilateral N60 of the MLSEP exit showed
the highest sensitivity which was 100% (95% CI: 86.7%–100%). The bilateral normal
N60 showed a high specificity of 97.5% (95% CI: 90.4%–99.6%). It also showed the highest
positive likelihood ratio of 6.25% (95% CI: 1.28%–30.59%), which was superior to N20
of SLSEP, V of BAEP, and Pa of MLAEP. The analysis demonstrated that the area under
the curve for MLSEP grading was the highest (0.838) compared to that of SLSEP grading
(0.784), MLAEP grading (0.659) and BAEP grading (0.621).
Conclusions
Compared with using N20 of SLSEP analysis alone, adding MLSEP improves the outcome
prediction in patients with severe ischemic brain injuries. When an outcome is uncertain
after initial evaluation using short-latency EPs, MLSEP is valuable to be used from
the first week to further improve prognostication in these patients.
Keywords
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Article info
Publication history
Published online: July 17, 2014
Accepted:
July 10,
2014
Received in revised form:
July 7,
2014
Received:
March 10,
2014
Identification
Copyright
© 2014 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
