Patterns of use of somatosensory-evoked potentials for comatose patients in Canada

To measure how frequently somatosensory-evoked potentials (SEPs) are used in comatose patients after traumatic brain injury (TBI) and hypoxic ischemic encephalopathy (HIE), how SEPs contribute to outcome prediction and clinical decision making, and how available they are to clinicians.

A novel factual and scenario-based survey instrument to measure patterns of SEPs use in comatose patients due to HIE or TBI was distributed to critical care, neurology, and neurosurgical physicians across Canada. The analysis was based on 86 completed surveys from specialists in neurology (36), neurosurgery (24), and critical care (22).

Most (73%) of respondents reported that SEPs were available. When provided clinical vignettes, only 36% indicated that they would use them in TBI and 49% would use them in HIE. When respondents ranked the various methods available for establishing prognosis for awakening, SEP was ranked after cerebral blood flow and magnetic resonance imaging. The majority did not accurately estimate chances of awakening when SEP responses were bilaterally absent.

There are significant opportunities to optimize the use of SEPs in comatose patients including standardizing SEP testing and reporting, better communicating results to critical care physicians, and improving the understanding regarding the recommended use and interpretation of these tests.