Thirumala Parthasarathy D, Thiagarajan Karthy, Gedela Satyanarayana, Crammond Donald J, Balzer Jeffrey R
Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
J Clin Neurosci. 2016 Mar;25:1-9. doi: 10.1016/j.jocn.2015.08.014. Epub 2015 Oct 21.
The 30 day stroke rate following carotid endarterectomy (CEA) ranges between 2-6%. Such periprocedural strokes are associated with a three-fold increased risk of mortality. Our primary aim was to determine the diagnostic accuracy of electroencephalogram (EEG) in predicting perioperative strokes through meta-analysis of existing literature. An extensive search for relevant literature was undertaken using PubMed and Web of Science databases. Studies were included after screening using predetermined criteria. Data was extracted and analyzed. Summary sensitivity, specificity and diagnostic odds ratio were obtained. Subgroup analysis of studies using eight or more EEG channels was done. Perioperative stroke rate for the cohort of 8765 patients was 1.75%. Pooled sensitivity and specificity of EEG changes in predicting these strokes were 52% (95% confidence interval [CI], 43-61%) and 84% (95% CI, 81-86%) respectively. Summary estimates of the subgroup were similar. The diagnostic odds ratio was 5.85 (95% CI, 3.71-9.22). For the observed stroke rate, the positive likelihood ratio was 3.25 while the negative predictive value was 98.99%. According to these results, patients with perioperative strokes have six times greater odds of experiencing an intraoperative change in EEG during CEA. EEG monitoring was found to be highly specific in predicting perioperative strokes after CEA.
颈动脉内膜切除术（CEA）后30天的卒中发生率在2%-6%之间。此类围手术期卒中与死亡率增加三倍相关。我们的主要目的是通过对现有文献的荟萃分析来确定脑电图（EEG）在预测围手术期卒中方面的诊断准确性。使用PubMed和科学网数据库对相关文献进行了广泛检索。根据预定标准筛选后纳入研究。提取并分析数据。获得汇总敏感性、特异性和诊断比值比。对使用八个或更多EEG通道的研究进行亚组分析。8765例患者队列的围手术期卒中发生率为1.75%。EEG变化在预测这些卒中方面的汇总敏感性和特异性分别为52%（95%置信区间[CI]，43%-61%）和84%（95%CI，81%-86%）。亚组的汇总估计值相似。诊断比值比为5.85（95%CI，3.71-9.22）。对于观察到的卒中发生率，阳性似然比为3.25，而阴性预测值为98.99%。根据这些结果，围手术期发生卒中的患者在CEA期间出现术中EEG变化的几率高六倍。发现EEG监测在预测CEA术后围手术期卒中方面具有高度特异性。
