OBJECTIVES: 

To investigate electroencephalogram (EEG) features’ relation with mortality or functional outcome after disorder of consciousness, stratifying patients between continuous EEG and routine EEG.

DESIGN: 

Retrospective analysis of data from a randomized controlled trial.

SETTING: 

Multiple adult ICUs.

PATIENTS: 

Data from 364 adults with acute disorder of consciousness, randomized to continuous EEG (30–48 hr; n = 182) or repeated 20-minute routine electroencephalogram (n = 182).

INTERVENTIONS: 

None.

MEASUREMENTS AND MAIN RESULTS: 

Correlations between electrographic features and mortality and modified Rankin scale at 6 months (good 0–2) were assessed. Background continuity, higher frequency, and reactivity correlated with survival and good modified Rankin scale. Rhythmic and periodic patterns carried dual prognostic information: lateralized periodic discharges were associated with mortality and bad modified Rankin scale. Generalized rhythmic delta activity correlated with survival, good modified Rankin scale, and lower occurrence of status epilepticus. Presence of sleep-spindles and continuous EEG background was associated with good outcome in the continuous EEG subgroup. In the routine EEG group, a model combining background frequency, continuity, reactivity, sleep-spindles, and lateralized periodic discharges was associated with mortality at 70.91% (95% CI, 59.62–80.10%) positive predictive value and 63.93% (95% CI, 58.67–68.89%) negative predictive value. In the continuous EEG group, a model combining background continuity, reactivity, generalized rhythmic delta activity, and lateralized periodic discharges was associated with mortality at 84.62% (95%CI, 75.02–90.97) positive predictive value and 74.77% (95% CI, 68.50–80.16) negative predictive value.

CONCLUSIONS: 

Standardized EEG interpretation provides reliable prognostic information. Continuous EEG provides more information than routine EEG.

中文翻译：

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连续与常规标准化脑电图用于危重成人预后预测：随机试验分析

目标： 

为了研究意识障碍后脑电图 (EEG) 特征与死亡率或功能结果的关系，将患者分为连续脑电图和常规脑电图。

设计： 

对随机对照试验数据的回顾性分析。

环境： 

多个成人 ICU。

患者： 

数据来自 364 名患有急性意识障碍的成年人，随机接受连续脑电图检查（30-48 小时；n = 182）或重复 20 分钟常规脑电图检查（n = 182）。

干预措施： 

没有任何。

测量和主要结果： 

评估了电图特征与死亡率和 6 个月时改良 Rankin 量表（良好 0-2）之间的相关性。背景连续性、较高的频率和反应性与生存率和良好的改良兰金量表相关。节律和周期性模式携带双重预后信息：偏侧周期性放电与死亡率和不良改良兰金量表相关。广义节律δ活动与生存、良好的改良Rankin量表以及较低的癫痫持续状态发生率相关。睡眠纺锤体和连续脑电图背景的存在与连续脑电图亚组的良好结果相关。在常规脑电图组中，结合背景频率、连续性、反应性、睡眠纺锤波和偏侧周期性放电的模型与死亡率相关，阳性预测值为 70.91%（95% CI，59.62–80.10%），阳性预测值为 63.93%（95%）。 CI，58.67–68.89%）阴性预测值。在连续脑电图组中，结合背景连续性、反应性、广义节律性δ活动和偏侧周期性放电的模型与死亡率相关，阳性预测值分别为 84.62% (95% CI, 75.02–90.97) 和 74.77% (95% CI, 68.50–80.16) 阴性预测值。

结论： 

标准化脑电图解释提供可靠的预后信息。连续脑电图比常规脑电图提供更多信息。