Related Experiment Video
Updated: Jan 28, 2026
A Method for Tracking the Time Evolution of Steady-State Evoked Potentials
Published on: May 25, 2019
Is it time to use evoked potentials to predict outcome in comatose children and adults?
S R Goodwin1, W A Friedman, M Bellefleur
1Department of Anesthesiology, University of Florida College of Medicine, Gainesville.
Insights
Multimodality-evoked potential recordings reliably predict poor outcomes in comatose children, with minimal false pessimism. While false optimism occurs, these tests aid clinical decisions for pediatric intensive care unit patients.
Area of Science:
- Neuroscience
- Clinical Neurology
- Pediatric Critical Care
Background:
- Comatose children require accurate prognostication for effective management.
- Predicting outcomes in pediatric intensive care unit (PICU) patients is challenging.
- Evoked potential recordings offer objective measures of neurological function.
Purpose of the Study:
- To evaluate the predictive value of multimodality-evoked potential (MMEP) recordings in comatose children.
- To assess the accuracy of MMEPs in forecasting patient outcomes.
- To determine the clinical utility of MMEPs in guiding treatment decisions.
Main Methods:
- Prospective study of 41 comatose children (Glasgow Coma Scale < 8) in a pediatric ICU.
- Brainstem auditory-evoked potential (BAEP) and somatosensory-evoked potential (SSEP) testing within 72 hours of admission.
- Literature review of 982 additional patients to assess predictive errors.
Main Results:
- MMEPs accurately predicted bad outcomes (death or vegetative state) with minimal false pessimism (0 in this series, 3 excluding neonates).
- Two false optimistic predictions occurred in the series; 99 in the literature review (excluding neonates).
- MMEPs showed high reliability in predicting poor neurological outcomes.
Conclusions:
- MMEP recordings are a valuable tool for predicting poor outcomes in comatose children.
- The low rate of false pessimism supports MMEP use in clinical decision-making.
- MMEPs serve as a useful adjunct to clinical assessment for guiding interventions in critically ill children.
Objective:
To determine the value of multimodality-evoked potential recordings in predicting outcome in comatose children.
Design:
Prospective series and literature review.
Setting:
Pediatric ICU in a university hospital.
Patients:
Forty-one children with a Glasgow Coma Scale score of less than 8, who were admitted to the pediatric ICU between 1984 and 1989.
Interventions:
Forty-one patients underwent brainstem auditory-evoked potential testing within 72 hrs of admission. Of these patients, 37 also had somatosensory-evoked potential testing at the same time. Four patients did not receive somatosensory-evoked potential testing for various nonmedical reasons.
Measurements And Main Results:
Multimodality-evoked potential recordings were used to predict outcome in these comatose children. Outcomes were categorized as bad (death or chronic vegetative state) or good (all other outcomes). Survivor outcomes were determined at discharge and on subsequent follow-up visits from 1 to 3 yrs later. There were no false pessimistic predictions, and two false optimistic predictions in this series. A comprehensive literature review of coma outcome prediction, using multimodality-evoked potential recordings, revealed 20 series with 982 additional patients in whom the predictive errors of false optimism and false pessimism could be determined. Five cases of false pessimism and 99 cases of false optimism were identified in the 982 additional patients. If neonates are excluded, the false pessimism number is reduced to three.
Conclusions:
A bad outcome can be reliably predicted using multimodality-evoked potential recordings with little chance of a false pessimistic prediction. The acceptable error of false optimism occurs frequently, since patients often die of progressive neurologic and nonneurologic problems that may or may not be present at the time of the evoked potential recordings. Thus, in comatose children, multimodality-evoked potential recordings are a useful adjunct to clinical examination and other diagnostic aids in predicting outcome and in making decisions regarding the degree of intervention to offer.
Related Concept Videos
02:24Predicting Reaction Outcomes
02:27Predicting Molecular Geometry
03:02Standard Electrode Potentials
01:13Outcomes of Glycolysis
Cellular respiration can occur aerobically (with oxygen) or anaerobically (without oxygen). In the presence of oxygen, cellular respiration starts with glycolysis and continues with pyruvate...
01:03Prediction Intervals
However, the point estimate is most likely not the exact value of the population parameter, but close to it. After calculating point estimates, we construct interval estimates, called confidence intervals or prediction intervals. This prediction interval comprises a range of values unlike the point estimate and is a better predictor of the observed sample value, y.
01:11Guidelines for Writing Outcome
Patient outcomes reflect the patient's response to the goal rather than what the nurse aims to achieve. Terminology should be observable and measurable to avoid the reader's interpretation. The desired outcome should be realistic and achievable in the designated care timeframe. Expected outcomes should align with adjunctive therapies. The outcome should enhance care...