title: Prognostic value of somatosensory evoked potentials in comatose children: a systematic literature review.
abstract: OBJECTIVE
  To review the predictive powers of SEPs in comatose children after acute brain injury.
  
  
  METHODS
  MEDLINE, EMBASE, OVID, ISI Web of Knowledge, BIOMED Central and the Cochrane Library (1981-2007) were searched. First, predictive values were calculated for each primary study. Second, we analysed effects of different factors on the SEP diagnostic odds ratio by meta-regression. Third, we compared SEP predictive values in children and in adults.
  
  
  RESULTS
  We selected 14 studies covering 732 patients; analysis was conducted in 11, while the other 3 were used for simple qualitative examination. In individual papers, the presence of SEP predicted favourable outcomes as shown by the area under both sROC curves being 0.958. The same value was shown by SEP absence for predicting unfavourable outcomes. All covariates showed no significant effects on diagnostic accuracy, but only a slight non-significant trend. For SEP grading, a simple sub-group analysis showed a high predictive value for non-awakening for absence of SEPs (PPV 97.0%) and a high prognostic power to predict awakening for normal SEPs (PPV 92.2%). Pathological SEPs did not show reliable predictivity. In children, the presence of SEPs showed a high prognostic power similar to that in adults.
  
  
  CONCLUSIONS
  This study supports the use of SEPs in the integrated process of outcome prediction after acute brain injury in children. Caution is recommended in predicting unfavourable outcomes in patients with an absence of SEPs in both TBI and HIE comas. Future studies are needed to resolve the issue of the effect of aetiology and age on SEP's predictive power.
authors.affiliation: SOD Neurofisiopatologia, DAI Scienze Neurologiche, Azienda Ospedaliera Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy. riccadoc@hotmail.com
authors.forename: Riccardo
authors.initials: R
authors.lastname: Carrai
authors.forename: Antonello
authors.initials: A
authors.lastname: Grippo
authors.forename: Silvia
authors.initials: S
authors.lastname: Lori
authors.forename: Francesco
authors.initials: F
authors.lastname: Pinto
authors.forename: Aldo
authors.initials: A
authors.lastname: Amantini
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003128:Coma / Q000503:physiopathology*; D005073:Evoked Potentials, Somatosensory; D006801:Humans; D011379:Prognosis; D012372:ROC Curve