Median nerve somatosensory evoked potentials and the Glasgow Coma Scale as predictors of outcome in comatose patients with head injuries.
Median nerve somatosensory evoked potential (SSEP) grades and Glasgow Coma Scale (GSC) scores were obtained from 51 patients with head injuries within 1 week after the injury to determine the relationship of these scores, both individually and combined, to outcome scores obtained more than 6 months after the injury. SSEP grading was based on the presence or absence of the cortical evoked potential, the amplitude of the early cortically generated P22 wave form, and the conduction time through the brain (P/N13-N20 interpeak latency). SSEP responses from both sides of the brain were combined and graded from 1 to 6. The GCS was graded without the verbal component (maximum score, 10), because all patients were intubated. All patients were unresponsive to commands. Median SSEP grades correlated better with Glasgow Outcome Scale and Barthel Index scores (R = 0.57 and 0.64, respectively; P less than 0.00001) than GCS scores did (R = 0.35 and 0.37, respectively, P less than 0.00001), and combining SSEP grades and GCS scores did not improve the predictive power of the model (R = 0.57 and 0.64, respectively; P less than 0.00001). All SSEP Grade 1 patients (n = 13) either died or remained in a vegetative state. In contrast, all SSEP Grade 6 patients (n = 7) had a moderate disability or good recovery. This study demonstrates the prognostic value of early quantitative median nerve SSEP grading for patients with head injuries who are unresponsive to commands within 1 week after the injury.
Houlden
D A
DA
Division of Neurosurgery, Sunnybrook Medical Centre, Toronto, Ontario, Canada.
Li
C
C
Schwartz
M L
ML
Katic
M
M
D000704:Analysis of Variance; D016009:Chi-Square Distribution; D003128:Coma / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005073:Evoked Potentials, Somatosensory; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008475:Median Nerve / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011930:Reaction Time; D012016:Reference Values