Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study

Marjolein M. Admiraal*, Anne Fleur van Rootselaar, Jeannette Hofmeijer, Cornelia W.E. Hoedemaekers, Christiaan R. van Kaam, Hanneke M. Keijzer, Michel J.A.M. van Putten, Marcus J. Schultz, Janneke Horn

*Corresponding author for this work

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Abstract

Objective: Outcome prediction in patients after cardiac arrest (CA) is challenging. Electroencephalographic reactivity (EEG-R) might be a reliable predictor. We aimed to determine the prognostic value of EEG-R using a standardized assessment. Methods: In a prospective cohort study, a strictly defined EEG-R assessment protocol was executed twice per day in adult patients after CA. EEG-R was classified as present or absent by 3 EEG readers, blinded to patient characteristics. Uncertain reactivity was classified as present. Primary outcome was best Cerebral Performance Category score (CPC) in 6 months after CA, dichotomized as good (CPC = 1–2) or poor (CPC = 3–5). EEG-R was considered reliable for predicting poor outcome if specificity was ≥95%. For good outcome prediction, a specificity of ≥80% was used. Added value of EEG-R was the increase in specificity when combined with EEG background, neurological examination, and somatosensory evoked potentials (SSEPs). Results: Of 160 patients enrolled, 149 were available for analyses. Absence of EEG-R for poor outcome prediction had a specificity of 82% and a sensitivity of 73%. For good outcome prediction, specificity was 73% and sensitivity 82%. Specificity for poor outcome prediction increased from 98% to 99% when EEG-R was added to a multimodal model. For good outcome prediction, specificity increased from 70% to 89%. Interpretation: EEG-R testing in itself is not sufficiently reliable for outcome prediction in patients after CA. For poor outcome prediction, it has no substantial added value to EEG background, neurological examination, and SSEPs. For prediction of good outcome, EEG-R seems to have added value. ANN NEUROL 2019.

Original languageEnglish
Pages (from-to)17-27
Number of pages11
JournalAnnals of Neurology
Volume86
Issue number1
Early online date24 May 2019
DOIs
Publication statusPublished - 1 Jul 2019

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Coma
Heart Arrest
Cohort Studies
Prospective Studies
Electroencephalography
Somatosensory Evoked Potentials
Neurologic Examination

Keywords

  • UT-Hybrid-D

Cite this

Admiraal, M. M., van Rootselaar, A. F., Hofmeijer, J., Hoedemaekers, C. W. E., van Kaam, C. R., Keijzer, H. M., ... Horn, J. (2019). Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma: A multicenter prospective cohort study. Annals of Neurology, 86(1), 17-27. https://doi.org/10.1002/ana.25507
Admiraal, Marjolein M. ; van Rootselaar, Anne Fleur ; Hofmeijer, Jeannette ; Hoedemaekers, Cornelia W.E. ; van Kaam, Christiaan R. ; Keijzer, Hanneke M. ; van Putten, Michel J.A.M. ; Schultz, Marcus J. ; Horn, Janneke. / Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma : A multicenter prospective cohort study. In: Annals of Neurology. 2019 ; Vol. 86, No. 1. pp. 17-27.
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abstract = "Objective: Outcome prediction in patients after cardiac arrest (CA) is challenging. Electroencephalographic reactivity (EEG-R) might be a reliable predictor. We aimed to determine the prognostic value of EEG-R using a standardized assessment. Methods: In a prospective cohort study, a strictly defined EEG-R assessment protocol was executed twice per day in adult patients after CA. EEG-R was classified as present or absent by 3 EEG readers, blinded to patient characteristics. Uncertain reactivity was classified as present. Primary outcome was best Cerebral Performance Category score (CPC) in 6 months after CA, dichotomized as good (CPC = 1–2) or poor (CPC = 3–5). EEG-R was considered reliable for predicting poor outcome if specificity was ≥95{\%}. For good outcome prediction, a specificity of ≥80{\%} was used. Added value of EEG-R was the increase in specificity when combined with EEG background, neurological examination, and somatosensory evoked potentials (SSEPs). Results: Of 160 patients enrolled, 149 were available for analyses. Absence of EEG-R for poor outcome prediction had a specificity of 82{\%} and a sensitivity of 73{\%}. For good outcome prediction, specificity was 73{\%} and sensitivity 82{\%}. Specificity for poor outcome prediction increased from 98{\%} to 99{\%} when EEG-R was added to a multimodal model. For good outcome prediction, specificity increased from 70{\%} to 89{\%}. Interpretation: EEG-R testing in itself is not sufficiently reliable for outcome prediction in patients after CA. For poor outcome prediction, it has no substantial added value to EEG background, neurological examination, and SSEPs. For prediction of good outcome, EEG-R seems to have added value. ANN NEUROL 2019.",
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Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma : A multicenter prospective cohort study. / Admiraal, Marjolein M.; van Rootselaar, Anne Fleur; Hofmeijer, Jeannette; Hoedemaekers, Cornelia W.E.; van Kaam, Christiaan R.; Keijzer, Hanneke M.; van Putten, Michel J.A.M.; Schultz, Marcus J.; Horn, Janneke.

In: Annals of Neurology, Vol. 86, No. 1, 01.07.2019, p. 17-27.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Electroencephalographic reactivity as predictor of neurological outcome in postanoxic coma

T2 - A multicenter prospective cohort study

AU - Admiraal, Marjolein M.

AU - van Rootselaar, Anne Fleur

AU - Hofmeijer, Jeannette

AU - Hoedemaekers, Cornelia W.E.

AU - van Kaam, Christiaan R.

AU - Keijzer, Hanneke M.

AU - van Putten, Michel J.A.M.

AU - Schultz, Marcus J.

AU - Horn, Janneke

N1 - Wiley deal

PY - 2019/7/1

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N2 - Objective: Outcome prediction in patients after cardiac arrest (CA) is challenging. Electroencephalographic reactivity (EEG-R) might be a reliable predictor. We aimed to determine the prognostic value of EEG-R using a standardized assessment. Methods: In a prospective cohort study, a strictly defined EEG-R assessment protocol was executed twice per day in adult patients after CA. EEG-R was classified as present or absent by 3 EEG readers, blinded to patient characteristics. Uncertain reactivity was classified as present. Primary outcome was best Cerebral Performance Category score (CPC) in 6 months after CA, dichotomized as good (CPC = 1–2) or poor (CPC = 3–5). EEG-R was considered reliable for predicting poor outcome if specificity was ≥95%. For good outcome prediction, a specificity of ≥80% was used. Added value of EEG-R was the increase in specificity when combined with EEG background, neurological examination, and somatosensory evoked potentials (SSEPs). Results: Of 160 patients enrolled, 149 were available for analyses. Absence of EEG-R for poor outcome prediction had a specificity of 82% and a sensitivity of 73%. For good outcome prediction, specificity was 73% and sensitivity 82%. Specificity for poor outcome prediction increased from 98% to 99% when EEG-R was added to a multimodal model. For good outcome prediction, specificity increased from 70% to 89%. Interpretation: EEG-R testing in itself is not sufficiently reliable for outcome prediction in patients after CA. For poor outcome prediction, it has no substantial added value to EEG background, neurological examination, and SSEPs. For prediction of good outcome, EEG-R seems to have added value. ANN NEUROL 2019.

AB - Objective: Outcome prediction in patients after cardiac arrest (CA) is challenging. Electroencephalographic reactivity (EEG-R) might be a reliable predictor. We aimed to determine the prognostic value of EEG-R using a standardized assessment. Methods: In a prospective cohort study, a strictly defined EEG-R assessment protocol was executed twice per day in adult patients after CA. EEG-R was classified as present or absent by 3 EEG readers, blinded to patient characteristics. Uncertain reactivity was classified as present. Primary outcome was best Cerebral Performance Category score (CPC) in 6 months after CA, dichotomized as good (CPC = 1–2) or poor (CPC = 3–5). EEG-R was considered reliable for predicting poor outcome if specificity was ≥95%. For good outcome prediction, a specificity of ≥80% was used. Added value of EEG-R was the increase in specificity when combined with EEG background, neurological examination, and somatosensory evoked potentials (SSEPs). Results: Of 160 patients enrolled, 149 were available for analyses. Absence of EEG-R for poor outcome prediction had a specificity of 82% and a sensitivity of 73%. For good outcome prediction, specificity was 73% and sensitivity 82%. Specificity for poor outcome prediction increased from 98% to 99% when EEG-R was added to a multimodal model. For good outcome prediction, specificity increased from 70% to 89%. Interpretation: EEG-R testing in itself is not sufficiently reliable for outcome prediction in patients after CA. For poor outcome prediction, it has no substantial added value to EEG background, neurological examination, and SSEPs. For prediction of good outcome, EEG-R seems to have added value. ANN NEUROL 2019.

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