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Prognostic value of somatosensory evoked potentials in comatose children: a systematic literature review
Riccardo Carrai1, Antonello Grippo, Silvia Lori
1SOD Neurofisiopatologia, DAI Scienze Neurologiche, Azienda Ospedaliera Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy. riccadoc@hotmail.com
Insights
Somatosensory evoked potentials (SEPs) accurately predict outcomes in comatose children after acute brain injury. Their absence strongly suggests unfavorable outcomes, while normal SEPs indicate a good prognosis.
Area of Science:
- Neuroscience
- Clinical Neurology
- Pediatric Critical Care
Background:
- Comatose children after acute brain injury face uncertain prognoses.
- Accurate outcome prediction is crucial for guiding clinical management and parental counseling.
- Somatosensory evoked potentials (SEPs) are electrophysiological tests that assess the integrity of sensory pathways.
Purpose of the Study:
- To systematically review and synthesize the predictive power of SEPs in comatose children following acute brain injury.
- To evaluate the diagnostic accuracy of SEPs for predicting outcomes in pediatric populations.
- To compare the predictive utility of SEPs in children versus adults.
Main Methods:
- A comprehensive literature search was conducted across multiple databases (MEDLINE, EMBASE, OVID, ISI Web of Knowledge, BIOMED Central, Cochrane Library) from 1981 to 2007.
- Predictive values were calculated for individual studies, and meta-regression analysis was used to assess the influence of covariates on diagnostic accuracy.
- Subgroup analyses were performed to evaluate SEP grading and compare pediatric and adult data.
Main Results:
- Analysis of 11 studies involving 732 patients revealed high predictive accuracy for SEPs (sROC AUC = 0.958 for both favorable and unfavorable outcomes).
- Absence of SEPs showed a high positive predictive value (PPV) of 97.0% for predicting non-awakening, while normal SEPs had a PPV of 92.2% for predicting awakening.
- Pathological SEPs demonstrated limited reliable predictivity; covariates did not significantly affect diagnostic accuracy. Pediatric SEP predictive power was comparable to that in adults.
Conclusions:
- SEPs are valuable tools for outcome prediction in comatose children with acute brain injury.
- Caution is advised when predicting unfavorable outcomes solely based on SEP absence in traumatic brain injury (TBI) and hypoxic-ischemic encephalopathy (HIE) comas.
- Further research is needed to clarify the impact of etiology and age on SEP predictive accuracy.
Purpose:
To review the predictive powers of SEPs in comatose children after acute brain injury.
Methods:
MEDLINE, EMBASE, OVID, ISI Web of Knowledge, BIOMED Central and the Cochrane Library (1981-2007) were searched. First, predictive values were calculated for each primary study. Second, we analysed effects of different factors on the SEP diagnostic odds ratio by meta-regression. Third, we compared SEP predictive values in children and in adults.
Results:
We selected 14 studies covering 732 patients; analysis was conducted in 11, while the other 3 were used for simple qualitative examination. In individual papers, the presence of SEP predicted favourable outcomes as shown by the area under both sROC curves being 0.958. The same value was shown by SEP absence for predicting unfavourable outcomes. All covariates showed no significant effects on diagnostic accuracy, but only a slight non-significant trend. For SEP grading, a simple sub-group analysis showed a high predictive value for non-awakening for absence of SEPs (PPV 97.0%) and a high prognostic power to predict awakening for normal SEPs (PPV 92.2%). Pathological SEPs did not show reliable predictivity. In children, the presence of SEPs showed a high prognostic power similar to that in adults.
Conclusion:
This study supports the use of SEPs in the integrated process of outcome prediction after acute brain injury in children. Caution is recommended in predicting unfavourable outcomes in patients with an absence of SEPs in both TBI and HIE comas. Future studies are needed to resolve the issue of the effect of aetiology and age on SEP's predictive power.
