PREDICTIVE VALUE OF BRAIN-STEM AUDITORY-EVOKED POTENTIALS IN CHILDREN WITH POSTTRAUMATIC COMA PRODUCED BY DIFFUSE BRAIN INJURY

In the present study, brain-stem auditory evoked potentials (BAEPs) in 31 children in posttraumatic 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 had 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.