The Combination Of Behavioral Scale And Neuroelectrophysiological Examination Applied In Prognosis Of Patients With Disorders Of Consciousness

BackgroundWith the development of critical medicine,the mortality of patients with brain injury caused by various reasons decreased rapidly.It comes that there is more and more patients with disorders of consciousness.It brings problems not only to the families and also to the society.According to different awareness and arousal level,DOC patients were divided into several groups.One is vegetative state or unresponsive wakefulness state,another is minimally conscious state.Patients in VS cannot be aware of themselves or the environment around them,but had the ability to breath and circulate and can open their eyes actively,with normal sleep and wake cycles.Minimally conscious state is patients with lowest but accurately exist awareness and it can be detected.Patients in VS or MCS had the essential difference,they would have entirely different outcome.so it is necessary to identify two states,and it is also conducive to the allocation of medical resources.But the identification of two states of consciousness is very difficult,it is reported that the misdiagnosis rate is as high as 43%.The better way to assess DOC patients was needed.CRS-R,functional MRI,PET and neurophysiological were used broadly in clinical now.Objective1.Compared different kind of methods,which were used to prognosis DOC patients commonly in clinical.2.Combined CRS-R,EEG standards,SEP standards and BCI online accuracy to predict the outcome of patients with disorders of consciousness.Subjects and Methods1.Subjects All the subjects were chosen from General Hospital of Guangzhou Military Command during october 2013 to June 2016.They all had acquired brain injury caused by various reasons,both VS and MCS were included.This study was admitted by the Ethics Committee of General Hospital of Guangzhou Military Command.And all the informed consent were got from the guardians.2.MethodsTThe basic information was recorded once the patients were admitted to hospitalization.CRS-R were finished in 48 hours and EEG and SEP were finished in 5 days.According to Lavizzari standards,EEG was classified to I-V levels.SEP was classified to ?-? levels according to Judson standards.All the patients were detected by BCI technology in 2 weeks.When the patients got the accuracy with significant difference we marked it as good one,vice versa.All the patients were followed up tested after 3 months or the onset of 6 months,according to Glasgow outcome score(Glasgow outcome scale,GOS)results grouping,3-5 divided into consciousness improvement group,1-2 group consiousness did notimprove.3.StatisticsSPSS 19.0 was used to analyze all the data.Firstly,all the factors that possibly influenced the outcome of DOC patients were analyzed by univariate analysis.T test was used for measurement data and ?2 or Fisher test was used for enumeration data.Then Logistic model was built by the factors selected from first step.Hosmer-Lemeshow and ROC curve were used to determine whether the model is good or not.Results1.The general data of patients49 patients were accepted in our study finally.38(78%)of them were male and 11(22%)were female.Patients were among 16-72 years old.Mean+SD was 39.7±14.3,38(78%)of 49 patients were in vegetative state and another 11(22%)were in minimally conscious state.22(45%)patients were traumatic brain injury and another 27(55%)were not.2.Results of univariate analysisAge,gender and etiology were not related to outcome of DOC patients.But CRS-R scores(P=0.000),EEG standards(P=0.002)and SEP standards(P=0.007)and BCI online accuracy(P=0.004)were related to outcome significantly.3.Results of Logistic regressionBCI online accuracy was related to the outcome of DOC patients strongly(OR=9.483,P=0.036).Then are EEG standards(OR=7.765,P=0.043)and SEP standards(OR=7.075,P=0.047).CRS-R score(OR=2.627,P=0.012)is the weakest one.Conclusion1.CRS-R scores,EEG standards,SEP standards and BCI online accuracy can be used to predict the outcome of patients with disorders of consciousness.2.BCI online accuracy is the most accurate method to predict outcome of DOC patients single.3.Combination of different assessment has the highest accuracy to predict the outcome of patients with DOC.