Department of Neurology, Massachusetts General Hospital, Boston, MA.
Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, MA.
Crit Care Med. 2018 Dec;46(12):e1213-e1221. doi: 10.1097/CCM.0000000000003436.
Absence of somatosensory evoked potentials is considered a nearly perfect predictor of poor outcome after cardiac arrest. However, reports of good outcomes despite absent somatosensory evoked potentials and high rates of withdrawal of life-sustaining therapies have raised concerns that estimates of the prognostic value of absent somatosensory evoked potentials may be biased by self-fulfilling prophecies. We aimed to develop an unbiased estimate of the false positive rate of absent somatosensory evoked potentials as a predictor of poor outcome after cardiac arrest.
PubMed.
We selected 35 studies in cardiac arrest prognostication that reported somatosensory evoked potentials.
In each study, we identified rates of withdrawal of life-sustaining therapies and good outcomes despite absent somatosensory evoked potentials. We appraised studies for potential biases using the Quality in Prognosis Studies tool. Using these data, we developed a statistical model to estimate the false positive rate of absent somatosensory evoked potentials adjusted for withdrawal of life-sustaining therapies rate.
Two-thousand one-hundred thirty-three subjects underwent somatosensory evoked potential testing. Five-hundred ninety-four had absent somatosensory evoked potentials; of these, 14 had good functional outcomes. The rate of withdrawal of life-sustaining therapies for subjects with absent somatosensory evoked potential could be estimated in 14 of the 35 studies (mean 80%, median 100%). The false positive rate for absent somatosensory evoked potential in predicting poor neurologic outcome, adjusted for a withdrawal of life-sustaining therapies rate of 80%, is 7.7% (95% CI, 4-13%).
Absent cortical somatosensory evoked potentials do not infallibly predict poor outcome in patients with coma following cardiac arrest. The chances of survival in subjects with absent somatosensory evoked potentials, though low, may be substantially higher than generally believed.
体感诱发电位缺失被认为是心脏骤停后预后不良的近乎完美的预测指标。然而，尽管体感诱发电位缺失且有较高的生命支持治疗撤机率，但仍有良好结局的报道，这引发了人们的担忧，即体感诱发电位缺失的预后价值估计可能受到自我实现预言的影响。我们旨在开发一种无偏的体感诱发电位缺失作为心脏骤停后预后不良的预测指标的假阳性率估计值。
PubMed。
我们选择了 35 项关于心脏骤停预后的研究，这些研究报告了体感诱发电位。
在每项研究中，我们确定了生命支持治疗撤机率和尽管体感诱发电位缺失但仍有良好结局的比例。我们使用预后研究质量工具评估了研究中的潜在偏倚。利用这些数据，我们开发了一种统计模型，以估计调整生命支持治疗撤机率后的体感诱发电位缺失的假阳性率。
2133 名受试者接受了体感诱发电位测试。594 名受试者的体感诱发电位缺失；其中，14 名受试者的神经功能良好。在 35 项研究中的 14 项研究中，可以估计有体感诱发电位缺失的受试者停止生命支持治疗的比率（平均 80%，中位数 100%）。调整 80%的生命支持治疗撤机率后，体感诱发电位缺失预测不良神经结局的假阳性率为 7.7%（95%CI，4-13%）。
皮质体感诱发电位缺失并不能可靠地预测心脏骤停后昏迷患者的不良预后。尽管体感诱发电位缺失的受试者的生存机会较低，但可能比普遍认为的要高得多。
