Are somatosensory evoked potentials the best predictor of outcome after severe brain injury? A systematic review
- B. G. CarterAffiliated withPaediatric Intensive Care Unit, Royal Children’s Hospital Email author
- , W. ButtAffiliated withPaediatric Intensive Care Unit, Royal Children’s Hospital
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Many tests have been used to predict outcome following severe brain injury. We compared predictive powers of clinical examination (pupillary responses, motor responses and Glasgow Coma Scale, GCS), electroencephalography (EEG) and computed tomography (CT) to that of somatosensory evoked potentials (SEPs) in a systematic review.
Materials and methods
Medline (1976–2002) and Embase (1980–2002) were searched, manual review of article reference lists was conducted, and authors were contacted. We selected 25 studies addressing the prediction of outcome after severe brain injury using SEPs and either GCS, EEG, CT, pupillary or motor responses. Outcomes were determined for patients with normal or bilaterally absent SEPs and graded measures of GCS, EEG, CT, pupillary responses or motor responses. For favourable outcome prediction SEPs were superior in sensitivity, specificity and positive and negative predictive values, except for pupillary responses which had superior sensitivity and GCS which had higher specificity. SEPs had superior summary receiver operating characteristic curves, with the exception of motor responses, and superior ratio of odds ratios. For unfavourable outcome prediction SEPs were superior to the other tests in sensitivity, specificity and positive and negative predictive values, except for motor and pupillary responses, GCS and CTs which had superior sensitivity. All SEP summary receiver operating characteristic curves and pooled ratio of odds ratios were superior.
Although imperfect, SEPs appear to be the best single overall predictor of outcome. There is sufficient evidence for clinicians to use SEPs in the prediction of outcome after brain injury.
KeywordsSomatosensory evoked potentials Glasgow coma scale Electroencephalography Computed tomography Brain injury Head injury
- Are somatosensory evoked potentials the best predictor of outcome after severe brain injury? A systematic review
Intensive Care Medicine
Volume 31, Issue 6 , pp 765-775
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Somatosensory evoked potentials
- Glasgow coma scale
- Computed tomography
- Brain injury
- Head injury
- Industry Sectors