Azabou Eric, Fischer Catherine, Mauguiere François, Vaugier Isabelle, Annane Djillali, Sharshar Tarek, Lofaso Fréderic
Department of Physiology and Functional Explorations and Department of Critical Care Medicine, Assistance Publique- Hôpitaux de Paris (AP-HP), Raymond Poincaré Hospital, INSERM U1173, University of Versailles St Quentin (UVSQ), Garches, France Department of Clinical Neurophysiology, Hospices Civils de Lyon, Neurological Hospital of Lyon, Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Université Lyon 1, Lyon, France
Department of Clinical Neurophysiology, Hospices Civils de Lyon, Neurological Hospital of Lyon, Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Université Lyon 1, Lyon, France.
Clin EEG Neurosci. 2016 Jan;47(1):75-82. doi: 10.1177/1550059415612375. Epub 2015 Nov 5.
We prospectively studied early bedside standard EEG characteristics in 61 acute postanoxic coma patients. Five simple EEG features, namely, isoelectric, discontinuous, nonreactive to intense auditory and nociceptive stimuli, dominant delta frequency, and occurrence of paroxysms were classified yes or no. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) of each of these variables for predicting an unfavorable outcome, defined as death, persistent vegetative state, minimally conscious state, or severe neurological disability, as assessed 1 year after coma onset were computed as well as Synek's score. The outcome was unfavorable in 56 (91.8%) patients. Sensitivity, specificity, PPV, NPV, and AUC of nonreactive EEG for predicting an unfavorable outcome were 84%, 80%, 98%, 31%, and 0.82, respectively; and were all very close to the ones of Synek score>3, which were 82%, 80%, 98%, 29%, and 0.81, respectively. Specificities for predicting an unfavorable outcome were 100% for isoelectric, discontinuous, or dominant delta activity EEG. These 3 last features were constantly associated to unfavorable outcome. Absent EEG reactivity strongly predicted an unfavorable outcome in postanoxic coma, and performed as accurate as a Synek score>3. Analyzing characteristics of some simple EEG features may easily help nonneurophysiologist physicians to investigate prognostic issue of postanoxic coma patient. In this study (a) discontinuous, isoelectric, or delta-dominant EEG were constantly associated with unfavorable outcome and (b) nonreactive EEG performed prognostic as accurate as a Synek score>3.
我们对61例急性缺氧后昏迷患者的早期床边标准脑电图特征进行了前瞻性研究。对五个简单的脑电图特征，即等电位、不连续、对强烈听觉和伤害性刺激无反应、优势δ频率以及是否出现阵发性活动进行了是或否的分类。计算了这些变量中每一个对于预测不良结局（定义为死亡、持续性植物状态、最低意识状态或严重神经功能残疾，在昏迷发作1年后进行评估）的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）以及受试者操作特征曲线下面积（AUC），同时计算了Synek评分。56例（91.8%）患者结局不良。脑电图无反应性预测不良结局的敏感性、特异性、PPV、NPV和AUC分别为84%、80%、98%、31%和0.82；并且都与Synek评分>3的情况非常接近，Synek评分>3时的相应数值分别为82%、80%、98%、29%和0.81。等电位、不连续或优势δ活动脑电图预测不良结局的特异性为100%。这最后三个特征始终与不良结局相关。脑电图反应性缺失强烈预测缺氧后昏迷的不良结局，其准确性与Synek评分>3相当。分析一些简单脑电图特征的特点可能有助于非神经生理学家的医生轻松研究缺氧后昏迷患者的预后问题。在本研究中，（a）不连续、等电位或δ波为主的脑电图始终与不良结局相关，（b）无反应性脑电图的预后准确性与Synek评分>3相当。
