Severe brain injury in children: long-term outcome and its prediction using somatosensory evoked potentials (SEPs).
OBJECTIVE
To evaluate the outcome of children 1 and 5 years after severe brain injury (Glasgow Coma Score < 8) using a functional measure [Glasgow Outcome Scale (GOS)] and a health status measure (the Torrance Health State (HUI:1)) and to determine the ability of somatosensory evoked potentials (SEPs) to predict these long-term outcomes.


METHODS
Prospective study.


METHODS
A 16-bed paediatric intensive care unit in a tertiary children's hospital.


METHODS
105 children with severe brain injury.


METHODS
SEPs were recorded once in the first week after admission. Outcome was assessed 1 and 5 years after injury using the GOS and at 5 years after injury using HUI:1.


RESULTS
At 5 years, using the GOS, 46 (43.8%) children had a good outcome, 10 (9.5%) were moderately disabled, 2 (1.9%) severely disabled, 3 (2.9%) vegetative and 44 (41.9%) had died. At 5 years, 17 of 40 (42.5%) survivors from 1 year had changed outcomes: 12 had improved, 3 had worsened and 2 had died. For a normal SEP, positive predictive power was 85.4%, sensitivity 62.5%, specificity 87.8%, negative predictive power 67.2% and the positive likelihood ratio was 5.1. For bilaterally absent responses, positive predictive power was 90.9%, sensitivity 61.2%, specificity 94.6%; negative predictive power 73.6% and the positive likelihood ratio was 11.4. Outcomes using HUI:1 were: 30 (28.6%) had a good quality of life, 21 (20.0%) had a moderate quality of life, 7 (6.7%) a poor quality, 44 died (41.9%) and 3 (2.9%) survived in a state deemed worse than death. For a normal SEP, positive predictive power was 85.4%, sensitivity 68.6%, specificity 88.9%, negative predictive power 75.0% and the positive likelihood ratio was 6.2. For bilaterally absent responses, positive predictive power was 93.9%, sensitivity 57.4%, specificity 96.1%, negative predictive power 68.1% and the positive likelihood ratio was 14.6.


CONCLUSIONS
The outcome for children with severe brain injury should be assessed 5 years after injury because important changes occur between 1 year and 5 years. Differences exist between outcomes assessed using the GOS and HUI:1 as they measure slightly different aspects of function. Consideration should therefore be given to using both measures. SEPs are excellent predictors of long-term outcome measured by either the GOS or the HUI:1.
Carter
B G
BG
Paediatric Intensive Care Unit, Royal Children's Hospital, Parkville, Australia. icutech@cryptic.rch.unimelb.edu.au
Taylor
A
A
Butt
W
W
D000293:Adolescent; D001930:Brain Injuries / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005073:Evoked Potentials, Somatosensory; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D017741:Survivors