Skip to main content
Article thumbnail
Location of Repository

Predictive value of neurological examination for early cortical responses to somatosensory evoked potentials in patients with postanoxic coma

By Aline Bouwes, Jan M. Binnekade, Bart W. Verbaan, Eveline G. J. Zandbergen, Johannes H. T. M. Koelman, Henry C. Weinstein, Albert Hijdra and Janneke Horn


Bilateral absence of cortical N20 responses of median nerve somatosensory evoked potentials (SEP) predicts poor neurological outcome in postanoxic coma after cardiopulmonary resuscitation (CPR). Although SEP is easy to perform and available in most hospitals, it is worthwhile to know how neurological signs are associated with SEP results. The aim of this study was to investigate whether specific clinical neurological signs are associated with either an absent or a present median nerve SEP in patients after CPR. Data from the previously published multicenter prospective cohort study PROPAC (prognosis in postanoxic coma, 2000–2003) were used. Neurological examination, consisting of Glasgow Coma Score (GCS) and brain stem reflexes, and SEP were performed 24, 48, and 72 h after CPR. Positive predictive values for predicting absent and present SEP, as well as diagnostic accuracy were calculated. Data of 407 patients were included. Of the 781 SEPs performed, N20 s were present in 401, bilaterally absent in 299, and 81 SEPs were technically undeterminable. The highest positive predictive values (0.63–0.91) for an absent SEP were found for absent pupillary light responses. The highest positive predictive values (0.71–0.83) for a present SEP were found for motor scores of withdrawal to painful stimuli or better. Multivariate analyses showed a fair diagnostic accuracy (0.78) for neurological examination in predicting an absent or present SEP at 48 or 72 h after CPR. This study shows that neurological examination cannot reliably predict absent or present cortical N20 responses in median nerve SEPs in patients after CPR

Topics: Original Communication
Publisher: Springer-Verlag
OAI identifier:
Provided by: PubMed Central
Download PDF:
Sorry, we are unable to provide the full text but you may find it at the following location(s):
  • http://www.pubmedcentral.nih.g... (external link)
  • Suggested articles


    1. (2008). A clinical and EEG scoring system that predicts early cortical response (N20) to somatosensory evoked potentials and outcome after cardiac arrest.
    2. (1996). Detection of nontraumatic comatose patients with no benefit of intensive care treatment by recording of sensory evoked potentials.
    3. (2010). Does hypothermia influence the predictive value of bilateral absent N20 after cardiac arrest?
    4. (1993). Early prediction of individual outcome after cardiopulmonary resuscitation.
    5. (1988). Effects of etomidate, midazolam, and thiopental on median nerve somatosensory evoked potentials and the additive effects of fentanyl and nitrous oxide.
    6. (1990). Effects of midazolam on median nerve somatosensory evoked potentials.
    7. (2000). Improved outcome prediction in unconscious cardiac arrest survivors with sensory evoked potentials compared with clinical assessment.
    8. (2006). Interobserver variation in the interpretation of SSEPs in anoxicischaemic coma.
    9. (1989). Median nerve evoked potentials during propofol anaesthesia.
    10. (2007). Plum and Posner’s diagnosis of stupor and coma, 4th edn.
    11. (2006). Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
    12. (1985). Predicting outcome from hypoxic-ischemic coma.
    13. (1991). Predicting outcome in hypoxic-ischemic coma: a prospective clinical and electrophysiologic study.
    14. (1987). Prediction of outcome after cardiac arrest. Crit Care Med
    15. (2006). Prediction of poor outcome within the first 3 days of postanoxic coma.
    16. (2007). Prediction of short-term and long-term outcomes after cardiac arrest: a prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations. Crit Care Med 35:1230–1237
    17. (2010). Predictors of neurologic outcome in hypothermia after cardiac arrest.
    18. (2008). Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest.
    19. (2010). Prognosis and prognostication after cardiac arrest and hypothermia; results of PROPACII, a Dutch multicenter, prospective cohort study. Intensive Care Med 36:S297
    20. (2010). Prognostication after cardiac arrest and hypothermia: a prospective study.
    21. (2011). Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia.
    22. (2005). Somatosensory and brainstem auditory evoked potentials in cardiac arrest patients treated with hypothermia. Crit Care Med 33:1736–1740
    23. (2009). Somatosensory evoked potentials during mild hypothermia after cardiopulmonary resuscitation.
    24. (2000). Somatosensory potentials, CSF creatine kinase BB activity, and awakening after cardiac arrest.
    25. (1977). The measurement of observer agreement for categorical data.
    26. (2009). The utility of median somatosensory evoked potentials in anoxic-ischemic coma.
    27. (2009). Validation of a new coma scale, the FOUR score, in the emergency department.
    28. (2005). Validation of a new coma scale: the FOUR score.

    To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.