title: Prospective Cohort Study Evaluating the Prognostic Value of Simple EEG Parameters in Postanoxic Coma.
abstract: We prospectively studied early bedside standard EEG characteristics in 61 acute postanoxic coma patients. Five simple EEG features, namely, isoelectric, discontinuous, nonreactive to intense auditory and nociceptive stimuli, dominant delta frequency, and occurrence of paroxysms were classified yes or no. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC) of each of these variables for predicting an unfavorable outcome, defined as death, persistent vegetative state, minimally conscious state, or severe neurological disability, as assessed 1 year after coma onset were computed as well as Synek's score. The outcome was unfavorable in 56 (91.8%) patients. Sensitivity, specificity, PPV, NPV, and AUC of nonreactive EEG for predicting an unfavorable outcome were 84%, 80%, 98%, 31%, and 0.82, respectively; and were all very close to the ones of Synek score>3, which were 82%, 80%, 98%, 29%, and 0.81, respectively. Specificities for predicting an unfavorable outcome were 100% for isoelectric, discontinuous, or dominant delta activity EEG. These 3 last features were constantly associated to unfavorable outcome. Absent EEG reactivity strongly predicted an unfavorable outcome in postanoxic coma, and performed as accurate as a Synek score>3. Analyzing characteristics of some simple EEG features may easily help nonneurophysiologist physicians to investigate prognostic issue of postanoxic coma patient. In this study (a) discontinuous, isoelectric, or delta-dominant EEG were constantly associated with unfavorable outcome and (b) nonreactive EEG performed prognostic as accurate as a Synek score>3.
authors.affiliation: Department of Physiology and Functional Explorations and Department of Critical Care Medicine, Assistance Publique- Hôpitaux de Paris (AP-HP), Raymond Poincaré Hospital, INSERM U1173, University of Versailles St Quentin (UVSQ), Garches, France Department of Clinical Neurophysiology, Hospices Civils de Lyon, Neurological Hospital of Lyon, Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Université Lyon 1, Lyon, France eric.azabou@rpc.ap-hop-paris.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Azabou
authors.affiliation: Department of Clinical Neurophysiology, Hospices Civils de Lyon, Neurological Hospital of Lyon, Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Université Lyon 1, Lyon, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Fischer
authors.affiliation: Department of Clinical Neurophysiology, Hospices Civils de Lyon, Neurological Hospital of Lyon, Lyon Neuroscience Research Center (CRNL), Brain Dynamics and Cognition Team (Dycog), INSERM U1028, CNRS UMR5292, Université Lyon 1, Lyon, France.
authors.forename: François
authors.initials: F
authors.lastname: Mauguiere
authors.affiliation: Department of Physiology and Functional Explorations and Department of Critical Care Medicine, Assistance Publique- Hôpitaux de Paris (AP-HP), Raymond Poincaré Hospital, INSERM U1173, University of Versailles St Quentin (UVSQ), Garches, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Vaugier
authors.affiliation: Department of Physiology and Functional Explorations and Department of Critical Care Medicine, Assistance Publique- Hôpitaux de Paris (AP-HP), Raymond Poincaré Hospital, INSERM U1173, University of Versailles St Quentin (UVSQ), Garches, France.
authors.forename: Djillali
authors.initials: D
authors.lastname: Annane
authors.affiliation: Department of Physiology and Functional Explorations and Department of Critical Care Medicine, Assistance Publique- Hôpitaux de Paris (AP-HP), Raymond Poincaré Hospital, INSERM U1173, University of Versailles St Quentin (UVSQ), Garches, France.
authors.forename: Tarek
authors.initials: T
authors.lastname: Sharshar
authors.affiliation: Department of Physiology and Functional Explorations and Department of Critical Care Medicine, Assistance Publique- Hôpitaux de Paris (AP-HP), Raymond Poincaré Hospital, INSERM U1173, University of Versailles St Quentin (UVSQ), Garches, France.
authors.forename: Fréderic
authors.initials: F
authors.lastname: Lofaso
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015331:Cohort Studies; D003128:Coma / Q000175:diagnosis* / Q000401:mortality*; D015897:Comorbidity; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004569:Electroencephalography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000150:complications* / Q000401:mortality*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015996:Survival Rate; D055815:Young Adult
keywords: EEG; EEG reactivity; ICU; Synek’s scale; outcome; postanoxic coma