 |
|
Detection of Nontraumatic Comatose Patients With No Benefit of Intensive Care Treatment by Recording of Sensory Evoked Potentials
Christian Madl, MD;
Ludwig Kramer, MD;
Wafa Yeganehfar, MD;
Edith Eisenhuber, MD;
Alexander Kranz, MD;
Klaus Ratheiser, MD;
Christian Zauner, MD;
Barbara Schneider, PhD;
Georg Grimm, MD, PhD
Arch Neurol. 1996;53(6):512-516.
Abstract
| |
Objectives
To determine the predictive ability of sensory evoked potential recordings in nontraumatic comatose patients. To evaluate the hypothesis that patients with bilateral absent cortical responses ultimately die despite long-term intensive care treatment.
Design
Prospective cohort study.
Setting
Medical intensive care unit (ICU) of a university hospital.
Patients
Four hundred forty-one adult nontraumatic comatose patients (unarousable unresponsiveness to external stimulation, Glasgow Coma Score  7) from various causes. Six hundred seventy-six sensory evoked potential measurements were performed within 7 days after onset of coma.
Main Outcome Measures
Death or survival to hospital discharge.
Results
Eighty-six patients (20%) had a bilateral loss of the cortical evoked potential N20 peak. Despite long-term intensive care treatment, all died without awakening from coma (mortality rate, 100%; 95% confidence interval, 96-100). The mean stay at the ICU after evoked potential measurement until death was 8.1 days (697 patient-days). The overall cost of ICU management for these 86 patients accounted for approximately $1 324 300. In the remaining 355 comatose patients with preserved cortical N20 peak, 148 (42%) survived and 207 (58%) died. In this latter group of patients, cervicomedullary N13 to cortical N20 conduction time was prolonged in nonsurvivors (mean±SD, 6.7±1.3 milliseconds) compared with that in survivors (mean±SD, 6.4±1.2 milliseconds, P<.05) and healthy controls (mean±SD, 5.5±0.4 milliseconds, P<.05). Although this difference is statistically significant, a preserved N20 peak is not useful to discriminate whether the individual patient will survive (N13-N20 conduction time of >7 milliseconds had a positive predictive value of correct prediction of death of 0.67).
Conclusions
Recording of sensory evoked potentials identifies a subgroup of adult nontraumatic comatose patients with a mortality rate of 100% in our sample. In these patients, advanced intensive care treatment should be withdrawn to provide limited ICU resources for patients with higher probability of favorable outcome. We emphasize that these results are not applicable to comatose patients following closed head trauma and particularly not to children.
Author Affiliations
From the Department of Medicine IV, Intensive Care Unit (Drs Madl, Kramer, Yeganehfar, Eisenhuber, Kranz, Ratheiser, Zauner, and Grimm), and Institute of Medical Statistics (Dr Schneider), University Hospital of Vienna, Vienna, Austria.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Prediction of poor outcome within the first 3 days of postanoxic coma
Zandbergen et al.
Neurology 2006;66:62-68.
ABSTRACT
| FULL TEXT
Part 4: Advanced Life Support
Circulation 2005;112:III-25-III-54.
FULL TEXT
Reversible hypoglycemic coma despite bilateral absence of the median nerve N20 evoked potential
Appoloni et al.
Neurology 2003;60:1723-1724.
FULL TEXT
Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest
Sherman et al.
Neurology 2000;54:889-894.
ABSTRACT
| FULL TEXT
Evoked Potentials Predict Death in Comatose Patients
Journal Watch Cardiology 1996;1996:18-18.
FULL TEXT
EVOKED POTENTIALS PREDICT DEATH IN COMATOSE PATIENTS
JWatch General 1996;1996:1-1.
FULL TEXT
|
