Prediction of awakening from hypothermic post anoxic coma based on auditory discrimination.

Détails

Ressource 1Télécharger: BIB_D4173B05D4AC.P001.pdf (1511.53 [Ko])
Etat: Serval
Version: Author's accepted manuscript
ID Serval
serval:BIB_D4173B05D4AC
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Prediction of awakening from hypothermic post anoxic coma based on auditory discrimination.
Périodique
Annals of Neurology
Auteur(s)
Tzovara A., Rossetti A.O., Juan E., Suys T., Viceic D., Rusca M., Oddo M., De Lucia M.
ISSN
1531-8249 (Electronic)
ISSN-L
0364-5134
Statut éditorial
Publié
Date de publication
05/2016
Peer-reviewed
Oui
Volume
79
Pages
748-757
Langue
anglais
Résumé
OBJECTIVE: Most of the available clinical tests for prognosis of post-anoxic coma are informative of poor outcome. Previous work has shown that an improvement in auditory discrimination over the first days of coma is predictive of awakening. Here, we aimed at evaluating this test on a large cohort of patients undergoing therapeutic hypothermia and at investigating its added value on existing clinical measures.
METHODS: We recorded electroencephalography responses to auditory stimuli in 94 comatose patients, under hypothermia and after re-warming to normal temperature. Auditory discrimination was semi-automatically quantified by decoding electroencephalography responses to frequently repeated vs. rare sounds. Outcome prediction was based on the change of decoding performance from hypothermia to normothermia.
RESULTS: An increase in auditory discrimination from hypothermia to normothermia was observed for 33 out of 94 patients. Among them, 27 awoke from coma, resulting in a positive predictive value of awakening of 82% (95% confidence interval: 0.65-0.93). Most non-survivors showing an improvement in auditory discrimination had incident status epilepticus. By excluding them, 27 out of 29 patients with improvement in auditory discrimination survived, resulting in a considerable improvement of the predictive value for awakening (93%, with 95% confidence interval: 0.77-0.99). Importantly, this test predicted the awakening of 13 out of 51 patients for which the outcome was uncertain based on current tests.
INTERPRETATION: The progression of auditory discrimination from hypothermia to normothermia has a high predictive value for awakening. This quantitative measure provides an added value to existing clinical tests and encourages the maintenance of life support. This article is protected by copyright. All rights reserved.
Pubmed
Web of science
Création de la notice
17/05/2016 11:10
Dernière modification de la notice
03/03/2018 21:42
Données d'usage