Thatcher R W, Cantor D S, McAlaster R, Geisler F, Krause P
Applied Neuroscience Research Institute, University of Maryland Eastern Shore, Princess Anne.
Ann N Y Acad Sci. 1991;620:82-101. doi: 10.1111/j.1749-6632.1991.tb51576.x.
A comprehensive diagnostic evaluation was administered to 162 closed head-injured patients within 1 to 21 days (mean, 7.5 days) after injury. Each evaluation consisted of (1) power spectral analyses of electroencephalogram (EEG) recorded from 19 scalp locations referenced to age-matched norms, (2) brainstem auditory evoked potentials, (3) computed tomography (CT)-scan, and (4) Glasgow Coma Score (GCS) at time of admission (GCS-A) and at time of EEG test (GCS-T). Functional outcome at one year following injury was assessed using the Rappaport Disability Rating Scale (DRS), which measures the level of disability in the six diagnostic categories of (1) eye opening, (2) best verbal response, (3) best motor response, (4) self-care ability for feeding, grooming, and toileting, (5) level of cognitive functioning, and (6) employability. The ability of the different diagnostic measures to predict outcome at one year following injury was assessed using stepwise discriminant analyses to identify patients in the extreme outcome categories of complete recovery versus death and multivariate regression analyses to predict patients with intermediate outcome scores. The best combination of predictor variables was EEG and GCS-T, which accounted for 74.6% of the variance in the multivariate regression analysis of intermediate outcome scores and 95.8% discriminant accuracy between good outcome and death. The best single predictors of outcome in both the discriminant analyses and the regression analyses were EEG coherence and phase. A gradient of prognostic strength of diagnostic measures was EEG phase greater than EEG coherence greater than GCS-T greater than CT-scan greater than EEG relative power. The value of EEG coherence and phase in the assessment of diffuse axonal injury was discussed.
在162例闭合性颅脑损伤患者受伤后1至21天（平均7.5天）内进行了全面的诊断评估。每次评估包括：（1）从19个头皮部位记录脑电图（EEG）的功率谱分析，并参照年龄匹配的标准；（2）脑干听觉诱发电位；（3）计算机断层扫描（CT）；（4）入院时（GCS-A）和EEG检查时（GCS-T）的格拉斯哥昏迷评分（GCS）。采用拉帕波特残疾评定量表（DRS）评估受伤后一年的功能结局，该量表测量六个诊断类别的残疾水平：（1）睁眼；（2）最佳言语反应；（3）最佳运动反应；（4）进食、梳洗和如厕的自我护理能力；（5）认知功能水平；（6）就业能力。采用逐步判别分析来识别完全康复与死亡这两个极端结局类别的患者，并采用多元回归分析来预测具有中等结局评分的患者，以此评估不同诊断措施预测受伤后一年结局的能力。预测变量的最佳组合是EEG和GCS-T，在中等结局评分的多元回归分析中，它们占方差的74.6%，在良好结局与死亡之间的判别准确率为95.8%。在判别分析和回归分析中，结局的最佳单一预测指标均为EEG相干性和相位。诊断措施的预后强度梯度为：EEG相位大于EEG相干性大于GCS-T大于CT扫描大于EEG相对功率。文中讨论了EEG相干性和相位在弥漫性轴索损伤评估中的价值。
