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Published on: January 11, 2016
Somatosensory evoked potentials in children with severe head trauma
Johannes Schalamon1, Georg Singer, Senta Kurschel
1Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, 8036 Graz, Austria. johannes.schalamon@meduni-graz.at
Insights
Somatosensory evoked potentials (SEP) effectively predict outcomes in children with severe traumatic brain injury (TBI). Absence of SEP indicates an unfavorable prognosis, while normal SEP suggests a better outcome, aiding early coma stage prognostication.
Area of Science:
- Neuroscience
- Clinical Neurology
- Pediatric Critical Care
Background:
- Severe traumatic brain injury (TBI) in children presents significant challenges in predicting neurological outcomes.
- Early prognostication is crucial for guiding clinical management and parental counseling in pediatric TBI cases.
Purpose of the Study:
- To evaluate the predictive value of somatosensory evoked potentials (SEP) for outcomes in pediatric patients with severe TBI.
- To determine the precision of SEP in predicting both favorable and unfavorable neurological outcomes.
Main Methods:
- Prospective clinical investigation in a Level I pediatric trauma center.
- Inclusion of 26 comatose pediatric patients (1 month to 17 years) with severe TBI (initial GCS ≤ 8).
- Recording of SEP, intracranial pressure, and cranial CT scans; outcome assessed using the Glasgow Outcome Scale (GOS).
Main Results:
- Thirteen children had normal SEP, three had abnormal SEP, and ten had bilaterally absent cortical responses.
- Absence of SEP was associated with unfavorable outcomes in all cases (death or persistent vegetative state).
- Normal SEP indicated a favorable outcome in most cases, but did not exclude mortality; unfavorable outcomes were predicted with higher precision.
Conclusions:
- Somatosensory evoked potentials provide valuable prognostic data in the early stages of coma following severe TBI in children.
- SEP are more precise in predicting unfavorable outcomes than favorable outcomes in this pediatric population.
- SEP assessment aids in early prognostication for pediatric severe TBI, complementing clinical and imaging data.
Unlabelled:
We evaluated the predictive value of somatosensory evoked potentials (SEP) in a series of children with severe traumatic brain injury (TBI). The prospective clinical investigation was performed in a Level I paediatric trauma centre. We included 26 consecutive comatose paediatric patients aged from 1 month to 17 years (median age 11 years) following severe TBI (initial Glasgow Coma Score (GCS) 8 or below). Besides SEP recordings, the intracranial pressure and the results of an initial cranial CT scan were filed. The Glasgow Outcome Scale (GOS) was used to assess outcome at discharge. Thirteen children had normal SEP measurements, three patients had abnormal SEP recordings and a cortical response was bilaterally absent in ten children. Out of 26 children, 10 died whereas two remained in a persistent vegetative state. Only one child suffered from significant neurological deficits (GOS 3) at discharge. Seven patients survived with a GOS of 4 and six children survived without neurological impairment (GOS 5). Normal SEP indicated a favourable outcome in most children but did not rule out the occurrence of death, while absence of SEP was related to unfavourable outcome in all cases.
Conclusion:
Measurement of somatosensory evoked potentials provides valuable data for determining the prognosis at early coma stages. Our data show that an unfavourable outcome can be predicted with higher precision than a favourable outcome.
