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Published on: March 26, 2019
Predictive value of brain-stem auditory evoked potentials in children with post-traumatic coma produced by diffuse
J Bosch Blancafort1, M Olesti Marco, J M Poch Puig
1Department of Neurosurgery, Hospital Universitari Materno-Infantil, Ciutat Sanitaria Vall d'Hebrón, Barcelona, Spain.
Insights
Brain-stem auditory evoked potentials (BAEPs) predict neurological recovery in children with post-traumatic coma. Normal BAEPs correlate with good outcomes, while abnormal or absent BAEPs indicate poor prognosis and higher mortality.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Diffuse brain injury in children can lead to post-traumatic coma, a critical condition with variable neurological outcomes.
- Assessing neurological recovery in pediatric coma is challenging, necessitating reliable prognostic indicators.
Purpose of the Study:
- To evaluate the predictive value of brain-stem auditory evoked potentials (BAEPs) for neurological recovery in children with post-traumatic coma.
- To correlate BAEP findings with clinical outcomes and neuroimaging results.
Main Methods:
- Brain-stem auditory evoked potentials (BAEPs) were recorded in 31 children within 72 hours of hospital admission for diffuse brain injury.
- Neurological recovery was assessed at 6 months post-injury, and findings were correlated with BAEPs, pupillary/corneal reflexes, Glasgow Coma Score, and CT scans.
Main Results:
- Children with normal, bilateral BAEPs showed good to excellent recovery (80% excellent).
- Abnormal BAEPs correlated with absent pupillary/corneal reflexes and higher mortality rates (all patients with absent BAEPs died).
- Normal BAEPs showed a strong correlation with visualized basal cisterns on CT scans.
Conclusions:
- BAEPs are a valuable tool for predicting neurological recovery in pediatric post-traumatic coma.
- Abnormalities in BAEPs are significant indicators of poor prognosis and increased mortality.
- BAEPs can complement clinical assessments and neuroimaging in managing children with severe head injuries.
Abstract:
In the present study, brain-stem auditory evoked potentials (BAEPs) in 31 children in post-traumatic coma with diffuse brain injury were examined. The BAEPs were recorded in the first 72 h after hospital admission and the findings of 29 patients related to the level of neurological recovery at 6 months after head injury. On the basis of the results, children were divided into three groups: the first consisted of children with bilateral and normal BAEPs (n = 19); the second of those with asymmetrical BAEPs (n = 6); and the third of those in whom BAEPs has disappeared or in whom only responses of the seventh cranial nerve and cochlear nucleus were recorded (n = 4). All the patients in the first group presented a good clinical outcome, with excellent recovery in 80%. In the second group three children (42.8%) had a good recovery, two (28.6%) were moderately disabled and one (14.3%) died of extraneurological causes. All the patients in the third group died. Abnormal BAEPs showed a significant correlation with absence of pupillary and/or corneal reflex, but not with the Glasgow Coma Score and anisocoria. Good statistical correlation was observed between normal BAEPs and visualization of basal cisterns on computed tomographic scan. The incidence of increased intracranial pressure was higher in patients with abnormal BAEPs, but the differences were not significant (P = 0.06). Our study confirms the predictive value of BAEPs in children's post-traumatic coma due to diffuse brain injury.
