A clinical and EEG scoring system that predicts early cortical response (N20) to somatosensory evoked potentials and outcome after cardiac arrest

doi:10.1186/1471-2261-8-35

BMC Cardiovascular Disorders
Volume 8

Viewing options:

Abstract
Full text
PDF (316KB)
Additional files

Associated material:

Related literature:

Articles citing this article
on Google Scholar
on ISI Web of Science
on PubMed Central
Other articles by authors
on Google Scholar

Daubin C
Guillotin D
Etard O
Gaillard C
du Cheyron D
Ramakers M
Bouchet B
Parienti JJ
Charbonneau P

on PubMed

Daubin C
Guillotin D
Etard O
Gaillard C
du Cheyron D
Ramakers M
Bouchet B
Parienti JJ
Charbonneau P
Related articles/pages
on Google

on Google Scholar

on PubMed

Tools:

Post to:

Research article

A clinical and EEG scoring system that predicts early cortical response (N20) to somatosensory evoked potentials and outcome after cardiac arrest

Cédric Daubin¹ , Damien Guillotin¹ , Olivier Etard² , Cathy Gaillard³ , Damien du Cheyron¹ , Michel Ramakers¹ , Bruno Bouchet¹ , Jean-Jacques Parienti³^,4 and Pierre Charbonneau¹

¹Department of Medical Intensive Care, Avenue Côte de Nacre, Caen University Hospital, 14033 Caen Cedex, France

²Laboratory of neurological functional exploratory, Avenue Côte de Nacre, Caen University Hospital, 14033 Caen Cedex, France

³Department of Biostatistics and Clinical Research, Avenue Côte de Nacre, Caen University Hospital, 14033 Caen Cedex, France

⁴Inserm UMR-S 707, Paris, F-75012, Université Pierre et Marie Curie-Paris6, UMR-S 707, Paris, F-75012, France

author email corresponding author email

BMC Cardiovascular Disorders 2008, 8:35doi:10.1186/1471-2261-8-35


Published:	4 December 2008

Abstract

Background

Anoxic coma following cardiac arrest is a common problem with ethical, social, and legal consequences. Except for unfavorable somatosensory-evoked potentials (SSEP) results, predictors of unfavorable outcome with a 100% specificity and a high sensitivity are lacking. The aim of the current research was to construct a clinical and EEG scoring system that predicts early cortical response (N20) to somatosensory evoked potentials and 6-months outcome in comatose patients after cardiac arrest.

Methods

We retrospectively reviewed the records of all consecutive patients who suffered cardiac arrest outside our hospital and were subsequently admitted to our facility from November 2002 to July 2006. We scored each case based on early clinical and EEG factors associated with unfavorable SSEPs, and we assessed the ability of this score to predict SSEP results and outcome.

Results

Sixty-six patients qualified for inclusion in the cohort. Among them, 34 (52%) had unfavorable SSEP results. At day three, factors independently associated with unfavorable SSEPs were: absence of corneal (14 points) and pupillary (21 points) reflexes, myoclonus (25 points), extensor or absent motor response to painful stimulation (28 points), and malignant EEG (11 points). A score >40 points had a sensitivity of 85%, a specificity of 84%, and a positive predictive value (PPV) of 85% to predict unfavorable SSEP results. A score >88 points had a PPV of 100%, but a sensitivity of 18%. Overall, this score had an area under ROC curves of 0.919. In addition, at day three, a score > 69 points had a PPV of 100% with a sensitivity of 32% to predict death or vegetative state.

Conclusion

A scoring system based on a combination of clinical and EEG findings can predict the absence of early cortical response to SSEPs. In settings without access to SSEPs, this score may help decision-making in a subset of comatose survivors after a cardiac arrest.