Log in | Register

Prognostic value of somatosensory evoked potentials in comatose children: a systematic literature review

Riccardo Carrai| Antonello Grippo| Silvia Lori| Francesco Pinto| Aldo Amantini
Review
Volume 36, Issue 7 / July , 2010

Pages 1112 - 1126

Abstract

Purpose

To review the predictive powers of SEPs in comatose children after acute brain injury.

Methods

MEDLINE, EMBASE, OVID, ISI Web of Knowledge, BIOMED Central and the Cochrane Library (1981–2007) were searched. First, predictive values were calculated for each primary study. Second, we analysed effects of different factors on the SEP diagnostic odds ratio by meta-regression. Third, we compared SEP predictive values in children and in adults.

Results

We selected 14 studies covering 732 patients; analysis was conducted in 11, while the other 3 were used for simple qualitative examination. In individual papers, the presence of SEP predicted favourable outcomes as shown by the area under both sROC curves being 0.958. The same value was shown by SEP absence for predicting unfavourable outcomes. All covariates showed no significant effects on diagnostic accuracy, but only a slight non-significant trend. For SEP grading, a simple sub-group analysis showed a high predictive value for non-awakening for absence of SEPs (PPV 97.0%) and a high prognostic power to predict awakening for normal SEPs (PPV 92.2%). Pathological SEPs did not show reliable predictivity. In children, the presence of SEPs showed a high prognostic power similar to that in adults.

Conclusion

This study supports the use of SEPs in the integrated process of outcome prediction after acute brain injury in children. Caution is recommended in predicting unfavourable outcomes in patients with an absence of SEPs in both TBI and HIE comas. Future studies are needed to resolve the issue of the effect of aetiology and age on SEP's predictive power.

Keywords

References

  1. Ashwal S (2004) Pediatric vegetative state: epidemiological and clinical issues. Neuro Rehabil 19:349–360
  2. Carter BG, Butt W (2001) Review of the use of somatosensory evoked potentials in the prediction of outcome after severe brain injury. Crit Care Med 29:178–186
    • View reference on publisher's website
    • View reference on PubMed
  3. Robinson LR, Micklesen PJ, Tirschwell DL, Lew HL (2003) Predictive value of somatosensory evoked potentials for awakening from coma. Crit Care Med 31:960–967
    • View reference on publisher's website
    • View reference on PubMed
  4. Carter BG, Butt W (2005) Are somatosensory evoked potentials the best predictor of outcome after severe brain injury? A systematic review. Int Care Med 31:765–775
    • View reference on publisher's website
  5. Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S, Quality Standards Subcommittee of the American Academy of Neurology (2006) Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review). Report of the quality standards subcommittee of the American Academy of Neurology. Neurology 67:203–210
    • View reference on publisher's website
    • View reference on PubMed
  6. Sterne JA, Egger M (2001) Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 54:1046–1055
    • View reference on publisher's website
    • View reference on PubMed
  7. Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25
    • View reference on publisher's website
    • View reference on PubMed
  8. Irwig L, Tosteson AN, Gatsonis C, Lau J, Colditz G, Chalmers TC, Mosteller F (1994) Guidelines for meta-analysis evaluating diagnostic test. Ann Intern Med 120:667–676
    • View reference on PubMed
  9. Sackett DL, Straus SE, Richardson SW, et al (eds) (2000) Evidence-based medicine. Harcourt Health Sci
  10. Villanueva EV, Zavarsek S (2004) Evaluating heterogeneity in cumulative meta-analyses. BMC Med Res Methods 4:18
    • View reference on publisher's website
  11. Higgins JPT, Green S (2008) Cochrane handbook for systematic reviews of interventions 5.0.1 [updated September 2008]. In: The Cochrane Library, issue 4, 2006. Wiley, Chichester
  12. Moses LE, Shapiro D, Littenberg B (1993) Combining independent studies of a diagnostic test into a summary ROC curve: data analytic approaches and some additional considerations. Stat Med 12:1293–1316
    • View reference on PubMed
  13. van Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21:589–624
    • View reference on publisher's website
    • View reference on PubMed
  14. Carter BG, Butt W (2005) A prospective study of outcome predictors after severe brain injury in children. Int Care Med 2005(31):840–845
    • View reference on publisher's website
  15. Schalamon J, Singer G, Kurschel S, Höllwarth ME (2005) Somatosensory evoked potentials in children with severe head trauma. Eur J Pediatr 164:417–420
    • View reference on publisher's website
    • View reference on PubMed
  16. Tomita Y, Fukuda C, Maegaki Y, Hanaki K, Kitagawa K, Sanpei M (2003) Re-evaluation of short latency somatosensory evoked potentials (P13, P14 and N18) for brainstem function in children who once suffered from deep coma. Brain Dev 25:352–356
    • View reference on publisher's website
    • View reference on PubMed
  17. Mandel R, Martinot A, Delepoulle F, Lamblin MD, Laureau E, Vallee L, Leclerc F (2002) Prediction of outcome after hypoxic-ischemic encephalopathy: a prospective clinical and electrophysiologic study. J Pediatr 141:45–50
    • View reference on publisher's website
    • View reference on PubMed
  18. Wohlrab G, Boltshauser E, Schmitt B (2001) Neurological outcome in comatose children with bilateral loss of cortical somatosensory evoked potentials. Neuropediatrics 32:271–274
    • View reference on publisher's website
    • View reference on PubMed
  19. Chéliout-Heraut F, Rubinsztajn R, Ioos C, Estournet B (2001) Prognostic value of evoked potentials and sleep recordings in the prolonged comatose state of children, preliminary data. Neurophysiol Clin 31:283–292
    • View reference on publisher's website
    • View reference on PubMed
  20. Carter BG, Taylor A, Butt W (1999) Severe brain injury in children: long-term outcome and its prediction using somatosensory evoked potentials (SEPs). Int Care Med 25:722–728
    • View reference on publisher's website
  21. Pohlmann-Eden B, Dingethal K, Bender HJ, Koelfen W (1997) How reliable is the predictive value of SEP (somatosensory evoked potentials) pattern in severe brain damage with special regard to the bilateral loss of cortical responses. Intensive Care Med 23:301–308
  22. Butinar D, Gostisa A (1996) Brainstem auditory evoked potentials and somatosensory evoked potentials in prediction of posttraumatic coma in children. Pflugers Arch 431(Suppl 2):R289–R290
    • View reference on publisher's website
    • View reference on PubMed
  23. Beca J, Cox PN, Taylor MJ, Bohn D, Butt W, Logan WJ, Rutka JT, Barker G (1995) Somatosensory evoked potentials for prediction of outcome in acute severe brain injury. J Pediatr 126:44–49
    • View reference on publisher's website
    • View reference on PubMed
  24. Zentner J, Rohde V (1994) SEP and MEP in comatose patients. Neurol Res 16:89–92
    • View reference on PubMed
  25. Goodwin SR, Bellefleur M, Friedman WA (1991) Is it time to use evoked potentials to predict outcome in comatose children and adults? Crit Care Med 19:518–524
    • View reference on publisher's website
    • View reference on PubMed
  26. Barelli A, Valente MR, Clemente A, Bozza P, Proietti R, Della Corte F (1991) Serial multimodality-evoked potentials in severely head-injured patients: diagnostic and prognostic implications. Crit Care Med 19:1374–1381
    • View reference on publisher's website
    • View reference on PubMed
  27. Facco E, Baratto F, Munari M, Donà B, Liviero MC, Behr AU, Giron GP (1991) Sensorimotor central conduction time in comatose patients. Electroencephalogr Clin Neurophysiol 80:469–476
    • View reference on publisher's website
    • View reference on PubMed
  28. Facco E, Munari M, Donà B, Baratto F, Fiore D, Behr AU, Giron G (1991) Spatial mapping of SEP in comatose patients: Improved outcome prediction by combined parietal N20 and frontal N30 analysis. Brain Topogr 3:447–455
    • View reference on publisher's website
    • View reference on PubMed
  29. Hutchinson DO, Frith RW, Shaw NA, Judson JA, Cant BR (1991) A comparison between electroencephalography and somatosensory evoked potentials for outcome prediction following severe head injury. Electroencephalogr Clin Neurophysiol 78:228–233
    • View reference on publisher's website
    • View reference on PubMed
  30. Judson JA, Cant BR, Shaw NA (1990) Early prediction of outcome from cerebral trauma by somatosensory evoked potentials. Crit Care Med 18:363–368
    • View reference on publisher's website
    • View reference on PubMed
  31. Lindsay K, Pasaoglu A, Hirst D, Allardyce G, Kennedy I, Teasdale G (1990) Somatosensory and auditory brain stem conduction after head injury: a comparison with clinical features in prediction of outcome. Neurosurgery 26:278–285
    • View reference on publisher's website
    • View reference on PubMed
  32. Parain D, Devaux AM, Proust B (1989) The contribution of EEG and evoked potentials in the post-anoxic prognosis of coma in children. Neurophysiol Clin 19:489–494
    • View reference on publisher's website
    • View reference on PubMed
  33. Taylor MJ, Farrell EJ (1989) Comparison of the prognostic utility of VEPs and SSEPs in comatose children. Pediatr Neurol 5:145–150
    • View reference on publisher's website
    • View reference on PubMed
  34. Zentner J, Ebner A (1988) Prognostic value of somatosensory and motor evoked potentials in patients with non-traumatic coma. Eur Arch Psychiatr Neurol Sci 237:184–187
    • View reference on publisher's website
  35. Goldie WD, Price RH (1988) Recovery from “brain death” with absent evoked potentials. J Clin Neurophysiol 5:354
  36. Ganes T, Lundar T (1988) EEG and evoked potentials in comatose patients with severe brain damage. Electroencephalogr Clin Neurophysiol 69:6–13
    • View reference on publisher's website
    • View reference on PubMed
  37. De Meirleir LJ, Taylor MJ (1987) Prognostic utility of SSEPs in comatose children. Pediatr Neurol 3:78–82
    • View reference on publisher's website
    • View reference on PubMed
  38. Whittle IR, Johnston IH, Besser M (1987) Short latency somatosensory evoked potentials in children. III. Findings following head injury. Surg Neurol 27:29–36
    • View reference on publisher's website
    • View reference on PubMed
  39. Sonnet ML, Floret D, Guillaume C, Fournet A, Motin J (1987) Les potentiels èvoqués chez les enfants comateux. Pediatrie 42:45–50
    • View reference on PubMed
  40. Cant BR, Hume AL, Judson JA, Shaw NA (1986) The assessment of severe head injury by short latency somatosensory and brain-stem auditory evoked potentials. Electroencephalogr Clin Neurophysiol 65:188–195
    • View reference on publisher's website
    • View reference on PubMed
  41. de Beyl DZ, Brunko E (1986) Prediction of chronic vegetative state with somatosensory evoked potentials. Neurology 36:134
  42. Frank LM, Furgiuele TL, Etheridge JE Jr (1985) Prediction of chronic vegetative state in children using evoked potentials. Neurology 35:931–934
    • View reference on PubMed
  43. White LE, Frank LM, Furgiuele TL et al (1985) Outcome with somatosensory and brainstem auditory evoked potentials. Ann Neurol 18:417
  44. Anderson DC, Bundlie S, Rockswold GL (1984) Multimodality evoked potentials in closed head trauma. Arch Neurol 41:369–374
    • View reference on PubMed
  45. Rumpl E, Prugger M, Gerstenbrand F, Hackl JM, Pallua A (1983) Central somatosensory conduction time and short latency somatosensory evoked potentials in post-traumatic coma. Electroencephalogr Clin Neurophysiol 56:583–596
    • View reference on publisher's website
    • View reference on PubMed
  46. Lütschg J, Pfenninger J, Ludin HP, Vassella F (1983) Brain-stem auditory evoked potentials and early somatosensory evoked potentials in neurointensively treated comatose children. Am J Dis Child 137:421–426
    • View reference on PubMed
  47. Greenberg RP, Newlon PG, Becker DP (1982) The somatosensory evoked potential in patients with severe head injury: outcome prediction and monitoring of brain function. Ann N Y Acad Sci 388:683–688
    • View reference on publisher's website
    • View reference on PubMed
  48. Lindsay KW, Carlin J, Kennedy I, Fry J, McInnes A, Teasdale GM (1981) Evoked potentials in severe head injury—analysis and relation to outcome. J Neurol Neurosurg Psychiatr 44:796–802
    • View reference on publisher's website
    • View reference on PubMed
  49. Goldie WD, Chiappa KH, Young RR, Brooks EB (1981) Brainstem auditory and short-latency somatosensory evoked responses in brain death. Neurology 31:248–256
    • View reference on PubMed
  50. Hume AL, Cant BR (1981) Central somatosensory conduction after head injury. Ann Neurol 10:411–419
    • View reference on publisher's website
    • View reference on PubMed
  51. Shewmon DA (2000) Coma prognosis in children part I: definitional and methodological challenges. J Clin Neurophysiol 17:457–466
    • View reference on publisher's website
    • View reference on PubMed
  52. Luerssen TG, Klauber MR, Marshall LF (1988) Outcome from head injury related to patient’s age. A longitudinal prospective study of adult and pediatric head injury. J Neurosurg 68:409–416
    • View reference on publisher's website
    • View reference on PubMed
  53. Vollmer DG, Torner JC, Jane JA et al (1991) Age and outcome following traumatic coma: why do older patients fare worse? J Neurosurg 75:S37–S49
  54. Levi L, Guilburd JN, Linn S, Feinsod M (1991) The association between skull fracture, intracranial pathology and outcome in pediatric head injury. Br J Neurosurg 5:617–625
    • View reference on publisher's website
    • View reference on PubMed
  55. Adams RD, Victor M (1995) Principles of Neurology. McGraw-Hill, New York
  56. Shevell M (2006) Office evaluation of the child with developmental delay. Semin Pediatr Neurol 13:256–261
    • View reference on publisher's website
    • View reference on PubMed
  57. Fiser DH (1992) Assessing the outcome of pediatric intensive care. J Pediatr 121:68–74
    • View reference on publisher's website
    • View reference on PubMed
  58. Boyer MG, Edwards P (1991) Outcome 1 to 3 years after severe traumatic brain injury in children and adolescents. Injury 22:315–320
    • View reference on publisher's website
    • View reference on PubMed
  59. Plum F, Posner JB (1983) The diagnosis of stupor and coma. FA, Davis
  60. Bates D (2001) The prognosis of medical coma. J Neurol Neurosurg Psychiatry 71(suppl I):i20–i23
    • View reference on PubMed
  61. Wong CP, Forsyth RJ, Kelly TP, Eyre JA (2001) Incidence, aetiology, and outcome of nontraumatic coma: a population based study. Arch Dis Child 84:193–199
    • View reference on publisher's website
    • View reference on PubMed
  62. Abend NS, Licht DJ (2008) Predicting outcome in children with hypoxic ischemic encephalopathy. Pediatr Crit Care Med 9:32–39
    • View reference on PubMed
  63. Lown B (1979) Sudden cardiac death: the major challenge confronting contemporary cardiology. Am J Cardiol 43:313–328
    • View reference on publisher's website
    • View reference on PubMed
  64. O’Carroll PW, Alkon E, Weiss B (1988) Drowning mortality in Los Angeles county, 1976 to 1984. JAMA 260:380–383
    • View reference on publisher's website
    • View reference on PubMed
  65. Amantini A, Grippo A, Fossi S, Cesaretti C, Piccioli A, Peris A, Ragazzoni A, Pinto F (2005) Prediction of ‘awakening’ and outcome in prolonged acute coma from severe traumatic brain injury: evidence for validity of short latency SEPs. Clin Neurophysiol 116:229–235
    • View reference on publisher's website
    • View reference on PubMed
  66. Glasziou P, Irwig L, Bain C, Colditz G (2001) Systematic review in health care. Cambridge University Press, Cambridge

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement