Liu Hua,Hu Jihong,He Jinhua,et al.Characteristics and prognostic value of somatosensory evoked potentials in children with disorder of consciousness during convalescence of severe brain injury[J].Journal of Clinical Pediatric Surgery,,22():538-543.[doi:10.3760/cma.j.cn101785-202208001-008]
Characteristics and prognostic value of somatosensory evoked potentials in children with disorder of consciousness during convalescence of severe brain injury
- Keywords:
- Brain Injuries; Consciousness Disorders; Neurophysiological Monitoring; Diagnosis; Prognosis; Child
- Abstract:
- Objective To explore the characteristics and prognostic values of somatosensory evoked potential (SEP) in children with disorder of consciousness during convalescence of severe brain injury, including minimal consciousness state (MCS) and vegetative state (VS).Methods From November 2017 to October 2021, clinical data were reviewed for 51 children with disorder of consciousness during convalescence of severe brain injury on inpatient rehabilitation treatment.24 cases were MCS and 27 cases were VS.All of them completed consciousness level assessments and SEP examination within 48 h after admission.Consciousness level was assessed by coma recovery scale-revised (CRS-R) and the outcomes were divided into clear consciousness and unregained consciousness.The deadline was at least 6 months after an onset of the disease.Based upon consciousness level, they were divided into two groups of MCS (n=24) and VS (n=27);according to different etiologies, three groups of traumatic brain injury, encephalitis and hypoxic ischemic encephalopathy were assigned.The SEP examination results were graded according to the Judson grading criteria.Grade Ⅰ was normal and grade Ⅱ/Ⅲ abnormal. Results At Month 6 post-onset, 30/51 cases regained consciousness while the remainders failed to recover consciousness.The consciousness recovery rate was 58.82%(30/51) and no death occurred.SEP grading of MCS group was better than that of VS group.However, the difference was not statistically significant (P>0.05).The recovery rate of consciousness was higher in MCS group (19/24, 79.17%) than that in VS group (11/27, 40.74%).And the difference was statistically significant (P<0.05).Statistically significant difference rxisted in the classification of SEP among three groups with different etiologies (P<0.05).SEP grading of traumatic brain injury group was the worst (2 cases of grade Ⅰ, 2 cases of grade Ⅱ, 14 cases of grade Ⅲ, respectively).Comparison of consciousness recovery rate among three groups with different etiologies:traumatic brain injury group (13/18) > encephalitis group (10/16) > hypoxic ischemic encephalopathy group (7/17).However, no significant difference existed among three groups (P>0.05).The difference in consciousness recovery rate was statistically significant among children with different SEP grades (P<0.05).The consciousness recovery rate of children with normal SEP (14/17) was significantly higher than that of children with abnormal SEP (16/34) and the difference was statistically significant (P<0.05).Using CRS-R as a gold standard for judging whether or not consciousness was lucid, the sensitivity, specificity and accuracy of SEP abnormality in assessing consciousness recovery in children with disorder of consciousnessin convalescence of severe brain injury were 85.71%(18/21), 46.67%(14/30) and 62.75%(32/51) respectively. Conclusion In children with disorder of consciousness during convalescence of severe brain injury, abnormal SEP is correlated with their consciousness recovery.Thus it has some application values in judging the consciousness recovery and prognosis of children with disorder of consciousness.
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Memo
收稿日期:2022-08-01。
基金项目:湖南省卫生健康委科研计划课题（202106041218）；湖南省残疾人康复科研项目（2021XK0308）
通讯作者:胡继红,Email:1211584458@qq.com