Haug Eric, Miner James, Dannehy Mark, Seigel Todd, Biros Michelle
Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415, USA.
Acad Emerg Med. 2004 Apr;11(4):349-52. doi: 10.1197/j.aem.2003.12.015.
Bispectral analysis of single-lead electroencephalographs (BIS) has proven valuable in assessing the level of awareness in sedated patients. In this study, the authors sought to determine if BIS values had a predictive value in patients with traumatic brain injuries (TBIs). Therefore, the objective was to determine in emergency department (ED) patients presenting with head trauma whether BIS and Glasgow Coma Scale score (GCS) prior to sedation would be sensitive and specific in predicting TBI.
A convenience sample of patients with known or suspected head trauma presenting between June and August of both 2001 and 2002 were entered into the study by having a BIS monitor placed immediately on presentation to the ED. BIS and GCS scores were collected every 2 minutes. Head computed tomography (CT) results and discharge dictations were then evaluated to determine the presence of TBI.
Fifty-two patients were entered into the study; 13 were excluded due to receiving sedatives prior to enrollment. Of the remaining 39 patients, 14 had intracranial hemorrhage on initial head CT. Of these 14, two had BIS scores over 95. Both of these were neurologically intact at discharge. Eleven of the 12 remaining patients died or left the hospital neurologically impaired. Of the patients with no abnormalities on initial head CT, 19 of 25 had initial BIS scores >95 and all left the hospital neurologically intact. Of the patients with normal initial head CT and initial BIS scores < 95, four of six died or were neurologically impaired at discharge. Twenty of 39 patients presented with an initial GCS of 15; four of 20 had an initial BIS score < 95, three of whom were neurologically impaired at discharge. The 16 of 20 with BIS >95 left the hospital neurologically intact. All patients with a GCS of 14 had BIS scores >95 and left the hospital neurologically intact. All patients with a GCS of 13 had initial BIS scores < 95 and were neurologically impaired at discharge. One patient with a GCS of 11 and a BIS score of 67 left the hospital neurologically intact; all other patients with a GCS < 12 had a BIS < 95 and left the hospital with a neurologic deficit.
BIS scores obtained prior to sedative medicines in the face of trauma are predictive of TBI and neurologic outcome at discharge.
单导联脑电图双谱分析（BIS）已被证明在评估镇静患者的意识水平方面具有重要价值。在本研究中，作者试图确定BIS值在创伤性脑损伤（TBI）患者中是否具有预测价值。因此，目的是确定在急诊科（ED）就诊的头部外伤患者中，镇静前的BIS和格拉斯哥昏迷量表评分（GCS）在预测TBI方面是否敏感且具有特异性。
选取2001年和2002年6月至8月期间已知或疑似头部外伤的患者作为便利样本，在其就诊于ED时立即放置BIS监测仪纳入研究。每2分钟收集一次BIS和GCS评分。然后评估头部计算机断层扫描（CT）结果和出院记录，以确定是否存在TBI。
52例患者纳入研究；13例因在入组前接受了镇静剂而被排除。其余39例患者中，14例初始头部CT显示颅内出血。在这14例患者中，2例BIS评分超过95。这2例患者出院时神经功能均完好。其余12例患者中有11例死亡或出院时神经功能受损。初始头部CT无异常的患者中，25例中有19例初始BIS评分>95，且均神经功能完好出院。初始头部CT正常且初始BIS评分<95的患者中，6例中有4例出院时死亡或神经功能受损。39例患者中有20例初始GCS为15；20例中有4例初始BIS评分<95，其中3例出院时神经功能受损。20例中BIS>95的16例患者神经功能完好出院。所有GCS为14的患者BIS评分>95，且神经功能完好出院。所有GCS为13的患者初始BIS评分<95，出院时神经功能受损。1例GCS为11且BIS评分为67的患者神经功能完好出院；所有其他GCS<12的患者BIS<95，出院时伴有神经功能缺损。
在创伤情况下，镇静药物使用前获得的BIS评分可预测TBI及出院时的神经功能结局。
