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Predicting Outcome in Postanoxic Coma: Are Ten EEG Electrodes Enough?
Marleen C Tjepkema-Cloostermans1, Jeannette Hofmeijer, Harold W Hom
1*Departments of Clinical Neurophysiology and Neurology, Medisch Spectrum Twente, Enschede, the Netherlands; †Clinical Neurophysiology, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands; ‡Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands; §Department of Intensive Care, Medisch Spectrum Twente, Enschede, the Netherlands; and ‖Department of Intensive Care, Rijnstate Hospital, Arnhem, the Netherlands.
Introduction:
Increasing evidence supports that early EEG recordings reliably contribute to outcome prediction in comatose patients with postanoxic encephalopathy. As postanoxic encephalopathy typically results in generalized EEG abnormalities, spatial resolution of a small number of electrodes is likely sufficient, which will reduce set-up time. Here, the authors compare a reduced and a 21-channel EEG for outcome prediction.
Methods:
EEG recordings from 142 prospectively collected patients with postanoxic encephalopathy were reassessed by two independent reviewers using a reduced (10 electrodes) bipolar montage. Classification and prognostic accuracy were compared with the full (21 electrodes) montage. The full montage consensus was considered Gold Standard.
Results:
Sixty-seven patients (47%) had good outcome. The agreement between the individual reviewers using the reduced montage and the Gold Standard score was good (κ = 0.75-0.79). The interobserver agreement was not affected by reducing the number of electrodes (κ = 0.78 for the reduced montage vs. 0.71 for the full montage). An isoelectric, low-voltage, or burst-suppression with identical bursts pattern at 24 hours invariably predicted poor outcome in both montages, with similar prognostic accuracy. A diffusely slowed or normal EEG pattern at 12 hours was associated with good outcome in both montages.
Conclusions:
Reducing the number of electrodes from 21 to 10 does not affect EEG classification or prognostic accuracy in patients with postanoxic coma.
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