Department of Neurology - Division of Neurocritical Care, University of California, San Francisco, USA.
Medical Scientist Training Program, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
Resuscitation. 2024 Oct;203:110377. doi: 10.1016/j.resuscitation.2024.110377. Epub 2024 Aug 24.
Somatosensory evoked potentials (SEPs) are highly specific predictors of poor prognosis in hypoxic-ischemic coma when cortical responses (N20s) are absent. However, bilateral N20 presence is nonspecific for good outcomes. High-frequency oscillations (HFOs) in the SEP waveform predict neurologic recovery in animals, but clinical applications are poorly understood. We sought to develop a clinical measure of HFOs to potentially improve detection of good outcomes in coma.
We collected SEP waveform data from all comatose inpatients (GCS<=8) who underwent neurologic prognostication from 2020 to 2022 at Johns Hopkins Hospital. We developed a novel measure - HFO evoked to spontaneous ratios (HFO-ESRs) - and applied this to those patients with bilaterally present N20s using both standard univariate classification and cubic kernal vector machine (SVM) models to predict the last documented in-hospital Glasgow Coma Scale (GCS) prior to discharge or death.
Of 58 total patients, 34 (58.6%) had bilaterally present N20s. Of these, 14 had final GCS>=9, and 20 had final GCS<=8. Mean age was 52 (+/- 17) years, 20.1% female. Etiologies of coma were primarily global hypoxic-ischemic brain injury (79.4%), intracranial hemorrhage (11.8%), and traumatic brain injury (2.9%). In univariate classification, the addition of averaged HFO-ESRs to bilaterally present N20s predicted final GCS>=9 with 68% specificity. The SVM model further improved specificity to 85%.
In this pilot investigation, we developed a novel clinical measure of SEP HFOs. Incorporation of this measure may improve the specificity of the SEP to predict in-hospital GCS outcomes in coma, but requires further validation in specific neurologic injuries and with longitudinal outcomes.
当皮质反应（N20）缺失时，体感诱发电位（SEP）是缺氧缺血性昏迷预后不良的高度特异性预测指标。然而，双侧 N20 存在对于良好结局是非特异性的。SEP 波形中的高频振荡（HFO）可预测动物的神经恢复，但临床应用尚不清楚。我们试图开发一种 HFO 的临床测量方法，以潜在提高昏迷患者对良好结局的检测能力。
我们从 2020 年至 2022 年在约翰霍普金斯医院接受神经预后评估的所有昏迷住院患者（GCS<=8）中收集 SEP 波形数据。我们开发了一种新的测量方法 - 自发 HFO 与诱发电位 HFO 的比值（HFO-ESRs）- 并将其应用于双侧 N20 存在的患者，使用标准的单变量分类和三次核向量机（SVM）模型来预测出院或死亡前最后一次记录的住院期间格拉斯哥昏迷量表（GCS）。
在 58 名患者中，34 名（58.6%）双侧 N20 存在。其中，14 名患者的最终 GCS>=9，20 名患者的最终 GCS<=8。平均年龄为 52（+/-17）岁，女性占 20.1%。昏迷的病因主要是全脑缺氧缺血性脑损伤（79.4%）、颅内出血（11.8%）和创伤性脑损伤（2.9%）。在单变量分类中，双侧 N20 存在时加入平均 HFO-ESRs 可预测最终 GCS>=9，特异性为 68%。SVM 模型进一步提高了特异性至 85%。
在这项初步研究中，我们开发了一种新的 SEP HFO 临床测量方法。该方法的应用可能会提高 SEP 预测昏迷患者住院期间 GCS 结局的特异性，但需要在特定的神经损伤和纵向结局中进一步验证。
