Estimating the False Positive Rate of Absent Somatosensory Evoked Potentials in Cardiac Arrest Prognostication

被引:48
作者
Amorim, Edilberto [1 ,2 ]
Ghassemi, Mohammad M. [3 ]
Lee, Jong W. [4 ]
Greer, David M. [5 ]
Kaplan, Peter W. [6 ]
Cole, Andrew J. [1 ]
Cash, Sydney S. [1 ]
Bianchi, Matthew T. [1 ]
Westover, M. Brandon [1 ]
机构
[1] Massachusetts Gen Hosp, Dept Neurol, Boston, MA 02114 USA
[2] MIT, Comp Sci & Artificial Intelligence Lab, 77 Massachusetts Ave, Cambridge, MA 02139 USA
[3] MIT, Dept Elect Engn & Comp Sci, Cambridge, MA 02139 USA
[4] Brigham & Womens Hosp, Dept Neurol, 75 Francis St, Boston, MA 02115 USA
[5] Boston Univ, Sch Med, Dept Neurol, Boston, MA 02118 USA
[6] Johns Hopkins Univ, Dept Neurol, Baltimore, MD 21218 USA
基金
美国国家卫生研究院;
关键词
critical care; evoked potentials; heart arrest; prognosis; TARGETED TEMPERATURE MANAGEMENT; ANOXIC-ISCHEMIC ENCEPHALOPATHY; MULTIMODAL OUTCOME PREDICTION; MILD THERAPEUTIC HYPOTHERMIA; NEURON-SPECIFIC ENOLASE; COMATOSE SURVIVORS; EEG; RESUSCITATION; PROGNOSIS; SSEP;
D O I
10.1097/CCM.0000000000003436
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: Absence of somatosensory evoked potentials is considered a nearly perfect predictor of poor outcome after cardiac arrest. However, reports of good outcomes despite absent somatosensory evoked potentials and high rates of withdrawal of life-sustaining therapies have raised concerns that estimates of the prognostic value of absent somatosensory evoked potentials may be biased by self-fulfilling prophecies. We aimed to develop an unbiased estimate of the false positive rate of absent somatosensory evoked potentials as a predictor of poor outcome after cardiac arrest. Data Sources: PubMed. Study Selection: We selected 35 studies in cardiac arrest prognostication that reported somatosensory evoked potentials. Data Extraction: In each study, we identified rates of withdrawal of life-sustaining therapies and good outcomes despite absent somatosensory evoked potentials. We appraised studies for potential biases using the Quality in Prognosis Studies tool. Using these data, we developed a statistical model to estimate the false positive rate of absent somatosensory evoked potentials adjusted for withdrawal of life-sustaining therapies rate. Data Synthesis: Two-thousand one-hundred thirty-three subjects underwent somatosensory evoked potential testing. Five-hundred ninety-four had absent somatosensory evoked potentials; of these, 14 had good functional outcomes. The rate of withdrawal of life-sustaining therapies for subjects with absent somatosensory evoked potential could be estimated in 14 of the 35 studies (mean 80%, median 100%). The false positive rate for absent somatosensory evoked potential in predicting poor neurologic outcome, adjusted for a withdrawal of life-sustaining therapies rate of 80%, is 7.7% (95% CI, 4-13%). Conclusions: Absent cortical somatosensory evoked potentials do not infallibly predict poor outcome in patients with coma following cardiac arrest. The chances of survival in subjects with absent somatosensory evoked potentials, though low, may be substantially higher than generally believed.
引用
收藏
页码:E1213 / E1221
页数:9
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