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Are somatosensory evoked potentials the best predictor of outcome after severe brain injury? A systematic review

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Abstract

Objective

Many tests have been used to predict outcome following severe brain injury. We compared predictive powers of clinical examination (pupillary responses, motor responses and Glasgow Coma Scale, GCS), electroencephalography (EEG) and computed tomography (CT) to that of somatosensory evoked potentials (SEPs) in a systematic review.

Materials and methods

Medline (1976–2002) and Embase (1980–2002) were searched, manual review of article reference lists was conducted, and authors were contacted. We selected 25 studies addressing the prediction of outcome after severe brain injury using SEPs and either GCS, EEG, CT, pupillary or motor responses. Outcomes were determined for patients with normal or bilaterally absent SEPs and graded measures of GCS, EEG, CT, pupillary responses or motor responses. For favourable outcome prediction SEPs were superior in sensitivity, specificity and positive and negative predictive values, except for pupillary responses which had superior sensitivity and GCS which had higher specificity. SEPs had superior summary receiver operating characteristic curves, with the exception of motor responses, and superior ratio of odds ratios. For unfavourable outcome prediction SEPs were superior to the other tests in sensitivity, specificity and positive and negative predictive values, except for motor and pupillary responses, GCS and CTs which had superior sensitivity. All SEP summary receiver operating characteristic curves and pooled ratio of odds ratios were superior.

Conclusions

Although imperfect, SEPs appear to be the best single overall predictor of outcome. There is sufficient evidence for clinicians to use SEPs in the prediction of outcome after brain injury.

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Acknowledgements

We thank Professor John Carlin and Professor Frank Shann for their advice and Cathy Gatt and Poh Chua for their assistance with the Embase database search and for obtaining studies. We are also indebted to the group of persons who helped translate the non-English-language papers required for the review: Dr. Andreas Schibler, Associate Professor Jim Tibballs, Jo Murphy, Dr. Alvaro Brilla, Dr. Doris Doberenz, Dr. Petra Schäffler, and Dr. Georg Staubli.

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  1. Paediatric Intensive Care Unit, Royal Children’s Hospital, Flemington Rd., 3052, Parkville, Melbourne, VIC, Australia

    B. G. Carter & W. Butt

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  1. B. G. Carter
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Correspondence to B. G. Carter.

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Carter, B.G., Butt, W. Are somatosensory evoked potentials the best predictor of outcome after severe brain injury? A systematic review. Intensive Care Med 31, 765–775 (2005). https://doi.org/10.1007/s00134-005-2633-1

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