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Severe brain injury in children: long-term outcome and its prediction using somatosensory evoked potentials (SEPs)
1Paediatric Intensive Care Unit, Royal Children's Hospital, Parkville, Australia. icutech@cryptic.rch.unimelb.edu.au
Insights
Outcomes for children with severe brain injury significantly change between 1 and 5 years, necessitating long-term assessment. Somatosensory evoked potentials (SEPs) accurately predict these outcomes, aiding in patient management.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Rehabilitation Medicine
Background:
- Severe brain injury in children (Glasgow Coma Score < 8) has significant long-term implications.
- Functional and health status outcomes require comprehensive evaluation beyond the initial year post-injury.
Purpose of the Study:
- To assess the 1- and 5-year outcomes of children with severe brain injury using the Glasgow Outcome Scale (GOS) and the Torrance Health State (HUI:1).
- To determine the predictive ability of somatosensory evoked potentials (SEPs) for these long-term outcomes.
Main Methods:
- Prospective study involving 105 children with severe brain injury in a tertiary children's hospital.
- Somatosensory evoked potentials (SEPs) recorded within the first week post-admission.
- Outcome assessment at 1 and 5 years using GOS, and at 5 years using HUI:1.
Main Results:
- At 5 years, 43.8% had good GOS outcomes, while 41.9% had died. Significant outcome changes occurred between 1 and 5 years in survivors.
- HUI:1 results showed 28.6% good quality of life, with 41.9% mortality.
- Normal SEPs had high positive predictive power (85.4% for GOS, 85.4% for HUI:1), and bilaterally absent SEPs showed even higher predictive values (90.9% for GOS, 93.9% for HUI:1).
Conclusions:
- Long-term outcome assessment at 5 years is crucial for children with severe brain injury due to significant changes occurring after the first year.
- The GOS and HUI:1 measure different functional aspects, suggesting the utility of using both for comprehensive evaluation.
- Somatosensory evoked potentials (SEPs) are highly effective predictors of long-term outcomes, whether measured by GOS or HUI:1.
Objective:
To evaluate the outcome of children 1 and 5 years after severe brain injury (Glasgow Coma Score < 8) using a functional measure [Glasgow Outcome Scale (GOS)] and a health status measure (the Torrance Health State (HUI:1)) and to determine the ability of somatosensory evoked potentials (SEPs) to predict these long-term outcomes.
Design:
Prospective study.
Setting:
A 16-bed paediatric intensive care unit in a tertiary children's hospital.
Patients And Participants:
105 children with severe brain injury.
Interventions:
SEPs were recorded once in the first week after admission. Outcome was assessed 1 and 5 years after injury using the GOS and at 5 years after injury using HUI:1.
Measurements And Results:
At 5 years, using the GOS, 46 (43.8%) children had a good outcome, 10 (9.5%) were moderately disabled, 2 (1.9%) severely disabled, 3 (2.9%) vegetative and 44 (41.9%) had died. At 5 years, 17 of 40 (42.5%) survivors from 1 year had changed outcomes: 12 had improved, 3 had worsened and 2 had died. For a normal SEP, positive predictive power was 85.4%, sensitivity 62.5%, specificity 87.8%, negative predictive power 67.2% and the positive likelihood ratio was 5.1. For bilaterally absent responses, positive predictive power was 90.9%, sensitivity 61.2%, specificity 94.6%; negative predictive power 73.6% and the positive likelihood ratio was 11.4. Outcomes using HUI:1 were: 30 (28.6%) had a good quality of life, 21 (20.0%) had a moderate quality of life, 7 (6.7%) a poor quality, 44 died (41.9%) and 3 (2.9%) survived in a state deemed worse than death. For a normal SEP, positive predictive power was 85.4%, sensitivity 68.6%, specificity 88.9%, negative predictive power 75.0% and the positive likelihood ratio was 6.2. For bilaterally absent responses, positive predictive power was 93.9%, sensitivity 57.4%, specificity 96.1%, negative predictive power 68.1% and the positive likelihood ratio was 14.6.
Conclusion:
The outcome for children with severe brain injury should be assessed 5 years after injury because important changes occur between 1 year and 5 years. Differences exist between outcomes assessed using the GOS and HUI:1 as they measure slightly different aspects of function. Consideration should therefore be given to using both measures. SEPs are excellent predictors of long-term outcome measured by either the GOS or the HUI:1.