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Published on: March 26, 2019
Search for clinical and neurophysiological prognostic patterns of brain coma outcomes in children
Rūta Liesiene1, Rimantas Kevalas, Ingrida Uloziene
1Department of Children Diseases, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania. ruta_liesiene@yahoo.com
Insights
Clinical examinations, electroencephalography (EEG), and brainstem auditory-evoked potentials (BAEPs) help predict outcomes in pediatric traumatic coma. Combining these neurophysiologic tests improves prognostic accuracy beyond the Glasgow Coma Scale alone.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
- Clinical Neurophysiology
Background:
- Traumatic coma in children presents significant challenges in predicting neurological outcomes.
- The Glasgow Coma Scale (GCS) is a standard assessment tool, but its prognostic value can be limited in severe head trauma.
- Objective neurophysiological investigations are crucial for a more comprehensive prognostic evaluation.
Purpose of the Study:
- To assess the predictive capabilities of clinical examinations combined with electroencephalography (EEG) and brainstem auditory-evoked potentials (BAEPs).
- To evaluate these parameters in pediatric patients experiencing traumatic coma.
- To determine their utility in predicting coma outcomes.
Main Methods:
- A cohort of 43 children with severe acute head trauma and coma was studied.
- Standard pediatric intensive care unit protocols were employed for evaluation and treatment.
- Glasgow Coma Scale (GCS) was used for coma assessment; EEG was recorded in 35 patients and BAEPs in 24.
Main Results:
- Lower GCS scores correlated with the presence of brain edema and longer recovery times for consciousness.
- Abnormal BAEPs (9 out of 24 cases) were associated with delayed or absent consciousness recovery (mean 44 days).
- EEG showed abnormalities in 57% of patients, including slow wave activity or "alpha coma" patterns.
Conclusions:
- Glasgow Coma Scale (GCS) alone has limited prognostic value in pediatric traumatic coma.
- Integrating EEG and BAEP findings with clinical data enhances prognostic accuracy.
- Pathological findings in BAEPs and EEG, alongside neuroimaging, indicate a poorer prognosis.
Objective:
The aim of the study was to evaluate the possible predictive values of clinical examinations combined with the recordings of electroencephalography and brainstem auditory-evoked potentials in traumatic coma of pediatric patients.
Material And Methods:
A total of 43 children in coma with severe acute head trauma were included in the study. They were investigated and treated in pediatric intensive care unit using standard evaluation and treatment protocol. Evaluation of coma was performed using Glasgow Coma Scale. Electroencephalography for 35 patients and brainstem auditory-evoked potentials for 24 patients were recorded.
Results:
Glasgow coma scale statistic pool median was equal to 4 points as measured in presence of brain edema, meanwhile it was 6 as measured in absence of edema. In case of supratentorial damage, median duration of consciousness recovery was 10 days. In absence of above-mentioned supratentorial damage, recovery of the consciousness was earlier - median was 5 days. Determined duration of artificial lung ventilation was statistically significantly shorter for those who had edema (P=0.048). In 20 patients (57% of all cases), constant or alternating slow wave activity was observed during the first electroencephalographic recording. In other cases, "alpha coma" or low amplitude of arrhythmic activity and local slowing activity corresponding to brain damage seen on computerized tomography were recorded. For 24 patients, brainstem auditory-evoked potentials were recorded. In 9 cases, they were abnormal; in these cases, the consciousness of the patients recovered after 44 days or did not recover.
Conclusions:
Glasgow coma scale results alone may have limited prognostic value in absence of other objective neurophysiologic investigation data concerning the coma outcome in children. Prognosis may be worse if pathological brainstem auditory-evoked potentials correlate with pathological dynamic changes in electroencephalography and brain lesions, diagnosed during computerized tomography scan.
