title: Predictive patterns of sensory evoked potentials in comatose brain injured patients evolving to brain death.
abstract: OBJECTIVE
  To assess whether Somatosensory Evoked Potentials (SEPs), recorded within 24h after ICU admission, are reliable predictors of brain death (BD) in comatose patients with acquired brain injury of various aetiologies.
  
  
  METHODS
  SEPs were classified as absent (A), pathological (P), and normal (N). Considering SEP recordings from both hemispheres, 6 patterns were identified: NN, NP, PP, NA, AP, and AA. The final endpoint was BD.
  
  
  RESULTS
  Of the 203 patients included in the study, 70 (34%) evolved toward BD. The survival analysis indicated that the combination of SEP patterns in a two-graded scale (grade 1: NN-NP-PP-NA, and grade 2: AP-AA), allowed for prediction of BD with the best accuracy. This aggregation predicted BD with a sensitivity of 75.7% (CI: 64-84), a specificity of 76.6% (CI: 68-83), a positive predictive value of 64.2% (CI: 53-74) and a negative predictive value of 84.3% (CI: 77-90) in overall patients, and with a sensitivity of 75.0% (CI: 63-84), a specificity of 84.9% (CI: 75-90), a positive predictive value of 77.5% (CI: 63-88) and a negative predictive value of 84.3% (CI: 74-91) when excluding cardiac arrest.
  
  
  CONCLUSIONS
  It is worth including SEPs, in association with other investigations and clinical signs, in prognostic scores of BD. The early identification of patients at high risk of evolving towards BD could help physicians to optimise management.
authors.affiliation: SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; Unità di Riabilitazione Neurologica, Fondazione Don Carlo Gnocchi, IRCCS, Florence, Italy.
authors.forename: Maenia
authors.initials: M
authors.lastname: Scarpino
authors.affiliation: SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Lanzo
authors.affiliation: SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; Unità di Riabilitazione Neurologica, Fondazione Don Carlo Gnocchi, IRCCS, Florence, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Carrai
authors.affiliation: SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lolli
authors.affiliation: Unità di Terapia Intensiva, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Migliaccio
authors.affiliation: SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Spalletti
authors.affiliation: Unità di Terapia Intensiva, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy.
authors.forename: Adriano
authors.initials: A
authors.lastname: Peris
authors.affiliation: SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; Unità di Riabilitazione Neurologica, Fondazione Don Carlo Gnocchi, IRCCS, Florence, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Amantini
authors.affiliation: SODc Neurofisiopatologia, Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, AOU Careggi, Florence, Italy; Unità di Riabilitazione Neurologica, Fondazione Don Carlo Gnocchi, IRCCS, Florence, Italy. Electronic address: agrippo@unifi.it.
authors.forename: Antonello
authors.initials: A
authors.lastname: Grippo
mesh_terms: D000368:Aged; D001921:Brain / Q000503:physiopathology*; D001926:Brain Death / Q000175:diagnosis* / Q000503:physiopathology; D001930:Brain Injuries / Q000150:complications*; D003128:Coma / Q000209:etiology / Q000503:physiopathology*; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000503:physiopathology; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016019:Survival Analysis
keywords: Brain death; Don d’organes; Mort cérébrale; Organ donation; Organ transplantation; Potentiels évoqués somesthésiques; Predictive score; Score prédictif; Somatosensory evoked potentials; Transplantation d’organes