OBJECTIVE: According to Electroencephalogram (EEG) descriptors included in the American-Clinical-Neurophysiology-Society (ACNS) terminology we generated a score, and we compared it to the EEG scores previously proposed in order to identify the one with the best prognostic power for neurological outcome at post-acute stages in patients with severe disorders of consciousness (DoC). MATERIALS AND METHODS: Patients included in the analysis were clinically evaluated with the Coma-Recovery-Scale-Revised (CRS-R). An EEG was performed within the first week after admission to Intensive Rehabilitation Unit (IRU). EEGs were classified according to the ACNS-terminology and to the scores of Bagnato and Estraneo. RESULTS: A total of 260 patients admitted to the IRU was analysed. A total of 160 patients (61%) improved their consciousness level during IRU stay. EEG score based on the ANCS-terminology showed higher overall performance (receiver-operating area under the curve=0.79) and greater sensitivity (65%), at comparable specificities (80%), for clinical improvement as compared to both CRS-R admission score and other EEG scores. Combining our EEG score with CRS-R score at admission, the cumulative sensitivity increased to 76% when at least one good prognostic index test was present in the same patient, whereas specificity increased up to 93% if both the good prognostic patterns of clinical and instrumental parameters were simultaneously present. CONCLUSION: The EEG scored according to the ACNS-terminology is the best amongst those looked at for the prediction of short-term clinical improvement in patients with DoC and represents a useful instrumental test, complementary to clinical evaluation at admission, to be added in post-acute neurological prognostication methods. This article is protected by copyright. All rights reserved.
OBJECTIVE: According to Electroencephalogram (EEG) descriptors included in the American-Clinical-Neurophysiology-Society (ACNS) terminology we generated a score, and we compared it to the EEG scores previously proposed in order to identify the one with the best prognostic power for neurological outcome at post-acute stages in patients with severe disorders of consciousness (DoC). MATERIALS AND METHODS:Patients included in the analysis were clinically evaluated with the Coma-Recovery-Scale-Revised (CRS-R). An EEG was performed within the first week after admission to Intensive Rehabilitation Unit (IRU). EEGs were classified according to the ACNS-terminology and to the scores of Bagnato and Estraneo. RESULTS: A total of 260 patients admitted to the IRU was analysed. A total of 160 patients (61%) improved their consciousness level during IRU stay. EEG score based on the ANCS-terminology showed higher overall performance (receiver-operating area under the curve=0.79) and greater sensitivity (65%), at comparable specificities (80%), for clinical improvement as compared to both CRS-R admission score and other EEG scores. Combining our EEG score with CRS-R score at admission, the cumulative sensitivity increased to 76% when at least one good prognostic index test was present in the same patient, whereas specificity increased up to 93% if both the good prognostic patterns of clinical and instrumental parameters were simultaneously present. CONCLUSION: The EEG scored according to the ACNS-terminology is the best amongst those looked at for the prediction of short-term clinical improvement in patients with DoC and represents a useful instrumental test, complementary to clinical evaluation at admission, to be added in post-acute neurological prognostication methods. This article is protected by copyright. All rights reserved.
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Keywords:
acquired brain injuries; electroencephalogram (EEG); post-acute prognosis; prognosis; severe disorders of consciousness; standardized EEG classification