Value of amplitude-integrated EEG combined with Full Outline of Unresponsiveness in evaluating the prognosis of children with disturbance of consciousness
ZHU Ling, BAI Zhen-Jiang, LI Ying
Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, Jiangsu 215000, China
Abstract：Objective To study the value of amplitude-integrated EEG (aEEG), Full Outline of Unresponsiveness (FOUR), and Glasgow Coma Scale (GCS) in evaluating the prognosis of children with disturbance of consciousness in the pediatric intensive care unit (PICU). Methods A total of 164 children with disturbance of consciousness who were admitted to the PICU of Children's Hospital Affiliated to Soochow University were enrolled as subjects. According to prognosis, they were divided into a poor prognosis group with 111 children and a good prognosis group with 53 children. The results of aEEG monitoring, FOUR score, and GCS score on days 1 and 5 of admission were collected. The association between evaluation methods and prognosis was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the value of aEEG, FOUR, and GCS in predicting prognosis. Results The children with no improvement or abnormal aggravation of aEEG on day 5 tended to have a poor prognosis. The results of aEEG was positively correlated with prognosis (r=0.689, P < 0.001), and FOUR and GCS were negatively correlated with prognosis (r=-0.655 and -0.554 respectively, P < 0.001). The areas under the ROC curve (AUC) of aEEG, FOUR, and GCS were 0.894, 0.903, and 0.840 respectively, and there was no significant difference in the AUC between the three indices (P > 0.05), while aEEG combined with FOUR had an AUC of 0.945, which was significantly larger than that of each index alone (P < 0.05). Conclusions Both aEEG and FOUR can be used as effective tools to predict the prognosis of children with disturbance of consciousness, and a combination of aEEG and FOUR can improve the predictive value.
ZHU Ling,BAI Zhen-Jiang,LI Ying. Value of amplitude-integrated EEG combined with Full Outline of Unresponsiveness in evaluating the prognosis of children with disturbance of consciousness[J]. CJCP, 2020, 22(11): 1183-1187.
Bruns N, Dransfeld F, Hüning B, et al. Comparison of two common aEEG classifications for the prediction of neurodevelopmental outcome in preterm infants[J]. Eur J Pediatr, 2017, 176(2):163-171.
[2]
Zubler F, Koenig C, Steimer A, et al. Prognostic and diagnostic value of EEG signal coupling measures in coma[J]. Clin Neurophysiol, 2016, 127(8):2942-2952.
[3]
Wijdicks EF, Bamlet WR, Maramattom BV, et al. Validation of a new coma scale:the FOUR score[J]. Ann Neurol, 2005, 58(4):585-593.
[4]
Jamal A, Sankhyan N, Jayashree M, et al. Full Outline of Unresponsiveness score and the Glasgow Coma Scale in prediction of pediatric coma[J]. World J Emerg Med, 2017, 8(1):55-60.
[5]
Zeiler FA, Lo BWY, Akoth E, et al. Predicting outcome in subarachnoid hemorrhage (SAH) utilizing the Full Outline of Unresponsiveness (FOUR) score[J]. Neurocrit Care, 2017, 27(3):381-391.
Beers SR, Wisniewski SR, Garcia-Filion P, et al. Validity of a pediatric version of the Glasgow Outcome Scale-Extended[J]. J Neurotrauma, 2012, 29(6):1126-1139.
[9]
Pignat JM, Mauron E, Jöhr J, et al. Outcome prediction of consciousness disorders in the acute stage based on a complementary motor behavioural tool[J]. PLoS One, 2016, 11(6):e0156882.
[10]
Kadivar M, Mosayebi Z, Badoo RS, et al. Evaluation of the efficacy of amplitude-integrated electroencephalography in the screening of newborns with metabolic disorder admitted to the NICU[J]. BMC Med Imaging, 2018, 18(1):33.
[11]
Rundgren M, Westhall E, Cronberg T, et al. Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients[J]. Crit Care Med, 2010, 38(9):1838-1844.
[12]
Schettler KF, Heineking B, Fernandez-Rodriguez S, et al. Guiding antiepileptic therapy in a pediatric patient with severe meningoencephalitis and decompressive craniectomy with the use of amplitude-integrated electroencephalography[J]. J Pediatr Intensive Care, 2017, 6(2):136-141.
[13]
Wijdicks EF, Kramer AA, Rohs T Jr, et al. Comparison of the Full Outline of Unresponsiveness score and the Glasgow Coma Scale in predicting mortality in critically ill patients*[J]. Crit Care Med, 2015, 43(2):439-444.
[14]
You W, Tang Q, Wu X, et al. Amplitude-integrated electroencephalography predicts outcome in patients with coma after acute brain injury[J]. Neurosci Bull, 2018, 34(4):639-646.
