Assessment of comatose patients: comparative analysis of electrophysiological techniques and clinical scores

To explore the correlation between different electrophysiological indicators, clinical scores, and coma prognosis, comparing predictive efficacy across diverse etiologies and lesion sites.

A total of 220 coma patients from Fujian Medical University Union Hospital were enrolled. Within one week of onset, we performed EEG, SLSEP, BAEP, the FOUR score and the GCS score on all patients. Three months after onset, we took the GOS score as a prognostic indicator for the patients and analyzed the relationship between different indicators of the abovementioned examinations and prognosis.

EEG Synek grade and SLSEP N20 demonstrated the strongest correlation with prognosis（EEG Synek, R² = 0.327, P < 0.001; SLSEP N20, R² = 0.231, P < 0.001), followed by the FOUR and the GCS scores (FOUR, R² = 0.165, P < 0.001; GCS, R² = 0.189, P < 0.001). EEG Synek grade predicted prognosis best in hypoxic-ischemic encephalopathy (R² = 0.462, P < 0.001, AUC = 0.900), while SLSEP N20 had the highest predictive specificity (100 %) in cerebrovascular disease. EEG Synek grading excelled in diffuse cortical lesions (R² = 0.329, P < 0.001, AUC = 0.870), with SLSEPN20 superior in subcortical lesions (specificity was 100 %). While the FOURscorehad the highest specificity (100 %) in diffuse cortical lesions. Brainstem auditory evoked potentials had limited predictive value in diffuse cortical coma.

EEG demonstrated good predictive value in the prognosis of coma resulting from hypoxic-ischemic encephalopathy and diffuse cortical lesions, while SLSEP showed better specificity in predicting the prognosis of coma caused by cerebrovascular disease and subcortical lesions. BAEP has poor sensitivity to diffuse cortical lesions.