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Prognostic value of somatosensory evoked potentials in comatose children: a systematic literature review

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Abstract

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.

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Acknowledgments

The authors thank Sonia Verdesca, MD (Neurological Rehabilitation Unit, Fond. Don C. Gnocchi, Centro Santa Maria agli Ulivi, Pozzolatico, Florence, Italy), for her helpful comments and suggestions during the English editing of the manuscript.

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Authors and Affiliations

  1. SOD Neurofisiopatologia, DAI Scienze Neurologiche, Azienda Ospedaliera Universitaria Careggi, Viale Morgagni 85, 50134, Florence, Italy

    Riccardo Carrai, Antonello Grippo, Silvia Lori, Francesco Pinto & Aldo Amantini

  2. UO Riabilitazione Respiratoria, Fond. Don C. Gnocchi ONLUS, IRCCS Pozzolatico, Florence, Italy

    Riccardo Carrai

  3. UO Riabilitazione Neurologica, Fond. Don C. Gnocchi ONLUS, IRCCS Pozzolatico, Florence, Italy

    Antonello Grippo

  4. Neurologia Pediatrica, Azienda Ospedaliera Universitaria “A. Meyer”, Florence, Italy

    Silvia Lori

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  1. Riccardo Carrai
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Correspondence to Riccardo Carrai.

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Carrai, R., Grippo, A., Lori, S. et al. Prognostic value of somatosensory evoked potentials in comatose children: a systematic literature review. Intensive Care Med 36, 1112–1126 (2010). https://doi.org/10.1007/s00134-010-1884-7

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