Prognostic value of neurophysiological evaluations in severe traumatic brain injury (TBI)

Abstract

Predicting outcome in the early phase after severe TBI is a major clinical challenge, particularly identifying patients at risk for the worse cognitive outcome. This single-center prospective study aimed to explore the predictive power of neurophysiological evaluations in the early phase following sTBI, and their relationship to functional and cognitive outcome 6–12 months post-injury. Prospective case series of patients admitted to the Neuro-ICU in the coma after sTBI, monitored with EEG or- SEP, with GCS ⩽ 8 at admission. EEG and SEPs recordings were scored in a standardized manner and categorized. We firstly focused on a subgroup of 46 sTBI admitted to the Neuro-ICU over a 1-year period (mean age = 48.6 years SD = 28.6), who received EEG and SEPs monitoring. Twenty-one (46%) patients died, while 6 (13%) did not regain consciousness. Patients underwent the first neurophysiological evaluations on day 2.8 ± 2.2. Considering non-reactive EEG pattern and pathological SEP, both measures together classified 70% of the patients into the unfavorable outcome group, after the first neurophysiological evaluation. We propose the combined neurophysiological monitoring of EEG with SEPs as an objective and reliable tool for evaluating brain function of sTBI coma patients.