Abstract
Brain injury from trauma, cardiac arrest or stroke is the most important cause of death and acquired disability in the paediatric population. Due to the lifetime impact of brain injury, there is a need for methods to stratify patient risk and ultimately predict outcome. Early prognosis is fundamental to the implementation of interventions to improve recovery, but no clinical model as yet exists. Healthy physiology is associated with a relative high variability of physiologic signals in organ systems. This was first evaluated in heart rate variability research. Brain variability can be quantified through electroencephalographic (EEG) phase synchrony. We hypothesised that variability in brain signals from EEG recordings would correlate with patient outcome after brain injury. Lower variability in EEG phase synchronization, would be associated with poor patient prognosis. A retrospective study, spanning 10 years (2000–2010) analysed the scalp EEGs of children aged 1 month to 17 years in coma (Glasgow Coma Scale, GCS, <8) admitted to the paediatric critical care unit (PCCU) following brain injury from TBI, cardiac arrest or stroke. Phase synchrony of the EEGs was evaluated using the Hilbert transform and the variability of the phase synchrony calculated. Outcome was evaluated using the 6 point Paediatric Performance Category Score (PCPC) based on chart review at the time of hospital discharge. Outcome was dichotomized to good outcome (PCPC score 1 to 3) and poor outcome (PCPC score 4 to 6). Children who had a poor outcome following brain injury secondary to cardiac arrest, TBI or stroke, had a higher magnitude of synchrony (R index), a lower spatial complexity of the synchrony patterns and a lower temporal variability of the synchrony index values at 15 Hz when compared to those patients with a good outcome.
Highlights
Brain injury is the most important cause of death and acquired disability in the paediatric population [1]
In our previous work in critically ill children post traumatic brain injury (TBI), we discovered a promising biomarker that focused on one aspect of the property of brain complexity
The results of our analysis indicate that children admitted to the paediatric critical care unit (PCCU) in coma with brain injury secondary to cardiac arrest, TBI or stroke who had a poor outcome (PCPC score 4 to 6) had a higher magnitude of phase synchrony (R index), lower spatial complexity of the synchrony patterns and lower temporal variability of the R index values at 15 Hz when compared to those patients with a good outcome (PCPC score 1 to 3)
Summary
Brain injury is the most important cause of death and acquired disability in the paediatric population [1]. Traumatic brain injury and ischemic brain injury are not discrete events but disease processes that evolve over time and the outcome of which can be improved with accurate and early diagnosis [6]. To reflect changing brain dynamics it would be performed in real-time. This could improve the type of treatment and its timeliness, as well as the prognostication of outcome [8]. The latter would help mitigate the distress, anxiety and the post-traumatic stress that can be experienced by families of patients as they wait and see what will happen to their child [9]
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