Prediction of severe traumatic brain injury outcome

Authors

  • T.V. Cherniy State Scientific Institution “Scientific and Practical Center of Preventive and Clinical Medicine” of the Agency of State Affairs, Kyiv, Ukraine
  • I.A. Andronova Donetsk National Medical University of the Ministry of Health of Ukraine, Lyman, Ukraine
  • V.I. Cherniy State Scientific Institution “Scientific and Practical Center of Preventive and Clinical Medicine” of the Agency of State Affairs, Kyiv, Ukraine
  • G.A. Gorodnik Donetsk National Medical University of the Ministry of Health of Ukraine, Lyman, Ukraine
  • K.V. Nazarenko Donetsk National Medical University of the Ministry of Health of Ukraine, Lyman, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.16.5.2020.212229

Keywords:

severe traumatic brain injury, autonomic state, brain death, EEG predictors of the course of a coma

Abstract

Background. An urgent problem of intensive care is the timely prediction of an outcome in patients with severe traumatic brain injury (STBI). The purpose of the study: in patients with a coma due to STBI, to identify prognostically significant electroencephalographic (EEG) predictors of the course of a coma: emerge from a coma, development of a vegetative state, and formation of the brain death. Materials and methods. An open-label, prospective case-control study involved 89 patients with a diagnosis of STBI complicated by coma stage I–II. According to the results of treatment, 89 patients were divided into three subgroups. The first subgroup consisted of 69 people emerged from a coma. The second one consisted of 7 patients in whom STBI resulted in a ve­getative state. The third subgroup included 13 individuals with fatal outcome of STBI; moreover, 6 of them were diagnosed with brain death formation. In the dynamics of therapy, an analysis of the level of consciousness was carried out according to the Glasgow coma scale, computed tomography data (Philips Brilliance CT), and quantitative EEG. Results. Prognostically significant EEG predictors for emerging from a coma are the restoration of interhemispheric coherence in the EEG alpha band in Fp1-Fp2, T3-T4, C3-02, Fp2-T3 leads and an increase in connectivity in the high-frequency beta 2-activity range in Fp1-Fp2 leads. Prognostically significant EEG predictors of the development of a vegetative state are decreased coherence in the pairs of central leads (С3-С4) in all ranges except the delta band. The development of a vegetative state is associated with interhemispheric dissociation and a decrease in the level of interactions between the reticular formation of the upper stem level and the system of non-specific regulation of the central nervous system at the diencephalic level. A sharp decrease in the coherence indicators in the Fp1-T4, Fp2-T3 frontotemporal areas of the cortex is an indicator of the breaking of direct and inverse coherence, the first signs of a breakdown of the nervous system. Conclusions. The use of quantitative EEG allows one to identify prognostically significant EEG predictors of the course of a coma: emerge from a coma, development of a vegetative state, and the formation of brain death.

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Published

2021-09-30

How to Cite

Cherniy, T., Andronova, I., Cherniy, V., Gorodnik, G., & Nazarenko, K. (2021). Prediction of severe traumatic brain injury outcome. EMERGENCY MEDICINE, 16(5), 87–94. https://doi.org/10.22141/2224-0586.16.5.2020.212229

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Original Researches

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