Prognostic Value Of Continuous Video-EEG In Traumatic And Non-traumatic Coma In Children

OBJECTIVES:To determine the prognostic value of continuous video-EEG in severe brain damage (traumatic and non-traumatic coma) in children, by correlating patterns of continuous VEEG and short-term outcome of patients.METHODS:Children with severe brain injury (traumatic and non-traumatic comatose, GCS<8) were selected from the PICU. Children were monitored for continuous VEEG within72hours after the onset of coma. The different patterns of VEEG and Young’s classification were analysed. The clinical outcomes were scored according to the Pediatric Cerebral and Overall Performance Category Scale (PCOPCS) and divided into three groups, favourable group, unfavourable group and severely unfavourable group. These clinical outcomes were then compared with the VEEG patterns using Chi-square test and multiple logistic regression analyses.RESULTS:Of the131patients,74male and29female, with age range of3.28+-3.46year old (mean0.12-14year old).39patients were in the favourable group while30patients were in the unfavourable and37patients were in the severely unfavourable group. During cEEG,31patients had electroencephalographic seizures, the majority without clinical accompaniment (non-convulsive seizures, NCS). Reactive electroencephalographic pattern, sleep architecture and Low-voltage have varied significantly in the different outcome groups (P<0.05) and correlated with the clinical outcomes. Epileptic discharge, status epilepticus and burst-suppression did not show any statistical significance in different outcome groups. Multiple logistic regression implied that GCS Score (OR=0.809,95%CI0.7141-0.9169; p=0.001) and Young’s classification score (OR=1.66,95%CI1.2769-2.1623; p<0.0005) correlated with clinical outcome. CONCLUSION:Comatose children with reactive electroencephalographic patterns, sleep architecture and lower score in Young’s classification have better clinical outcome in terms of morbidity and mortality. Young’s classification score both have great value and significance in determining the clinical outcomes in the severe brain damage children, but need to be modified. GCS Score can also show the prediction. A careful assessment of electroencephalographic patterns and features in all comatose children is required for better understanding of the clinical outcome.