School of Psychology, University of Birmingham, Birmingham, UK.
Centre for Human Brain Health, University of Birmingham, Birmingham, UK.
Ann Neurol. 2021 Apr;89(4):646-656. doi: 10.1002/ana.25995. Epub 2021 Jan 9.
Patients with traumatic brain injury who fail to obey commands after sedation-washout pose one of the most significant challenges for neurological prognostication. Reducing prognostic uncertainty will lead to more appropriate care decisions and ensure provision of limited rehabilitation resources to those most likely to benefit. Bedside markers of covert residual cognition, including speech comprehension, may reduce this uncertainty.
We recruited 28 patients with acute traumatic brain injury who were 2 to 7 days sedation-free and failed to obey commands. Patients heard streams of isochronous monosyllabic words that built meaningful phrases and sentences while their brain activity via electroencephalography (EEG) was recorded. In healthy individuals, EEG activity only synchronizes with the rhythm of phrases and sentences when listeners consciously comprehend the speech. This approach therefore provides a measure of residual speech comprehension in unresponsive patients.
Seventeen and 16 patients were available for assessment with the Glasgow Outcome Scale Extended (GOSE) at 3 months and 6 months, respectively. Outcome significantly correlated with the strength of patients' acute cortical tracking of phrases and sentences (r > 0.6, p < 0.007), quantified by inter-trial phase coherence. Linear regressions revealed that the strength of this comprehension response (beta = 0.603, p = 0.006) significantly improved the accuracy of prognoses relative to clinical characteristics alone (eg, Glasgow Coma Scale [GCS], computed tomography [CT] grade).
A simple, passive, auditory EEG protocol improves prognostic accuracy in a critical period of clinical decision making. Unlike other approaches to probing covert cognition for prognostication, this approach is entirely passive and therefore less susceptible to cognitive deficits, increasing the number of patients who may benefit. ANN NEUROL 2021;89:646-656.
在镇静-冲洗后不服从命令的创伤性脑损伤患者是神经预后预测中最具挑战性的问题之一。降低预后的不确定性将导致更适当的护理决策，并确保将有限的康复资源提供给最有可能受益的患者。床边隐匿性认知残留的标志物，包括言语理解，可能会降低这种不确定性。
我们招募了 28 名急性创伤性脑损伤患者，这些患者在镇静洗脱后 2 至 7 天内无法服从命令。当患者的大脑活动通过脑电图（EEG）记录时，他们听到了一系列等时的单音节词，这些词构建了有意义的短语和句子。在健康个体中，只有当听众有意识地理解言语时，EEG 活动才会与短语和句子的节奏同步。因此，这种方法为无反应患者提供了残留言语理解的测量。
分别有 17 名和 16 名患者可用于 3 个月和 6 个月的格拉斯哥预后量表扩展（GOSE）评估。结果与患者急性皮质对短语和句子的跟踪强度显著相关（r > 0.6，p < 0.007），由试验间相位相干性量化。线性回归显示，这种理解反应的强度（β=0.603，p=0.006）显著提高了相对于单独临床特征（如格拉斯哥昏迷量表[GCS]、计算机断层扫描[CT]分级）的预后准确性。
一种简单、被动、听觉脑电图方案可改善临床决策关键时期的预后准确性。与用于预后预测的其他探测隐匿性认知的方法不同，这种方法完全是被动的，因此不易受到认知缺陷的影响，从而增加了可能受益的患者数量。神经病学年鉴 2021；89：646-656。
