Diagnosis And Prognostic Of Narcotrend And Bispectral Index In Patients With Disorders Of Consciousness

Objective:As objective means,Narcotrend(NT)and bispectral index(BIS)were used to distinguish the different states of consciousness in patients with disorders of consciousness,and particularly distinguish between coma and chronic disorders of consciousness(cDOC),vegetative state(VS)and minimally conscious state(MCS)are grouped into cDOC.Meanwhile,prognostic value of Narcotrend index(NI)and BIS was explored for patients with disorders of consciousness after one year.Methods:All the subjects we choose were hospitalized in the department of neurological intensive care unit and the first department of neurological rehabilitation from Guangzhou Military Command of General Hospital from January 2017 to September 2017.We used NT,BIS and clinical behavioural assessments to monitor dynamically the patients' brain function.Then NI,BIS,glasgow coma scale(GCS)and coma recovery scale-revised(CRS-R)from different concious states were recorded.Finally,we make glasgow outcome scale(GOS)for the subject after one year.Results:In all 66 patients,184 pieces of data from the NI,BIS and the scores of clinical behavioural assessments were collected.BIS values and NI showed a positive correlation with GCS.NI shows stronger correlation than BIS to GCS,which means that NI was better at the dignosis of coma.BIS values and NI also showed a positive correlation withCRS-R.BIS shows stronger correlation than NI to CRS-R,which meant that BIS was better at the dignosis of cDOC.The cDOC patient had higher BIS and NI than comatose patient,which meant that BIS and NI could distinguish coma from cDOC.The patient in VS had lower BIS than MCS patient,which meant that BIS also could disentangle VS from MCS.The result of logistic regression and receiver operating characteristic curve(ROC curve)showed that NI was more accurate in diagnosis of different consciouss states.BIS was more accurate in the dignosis of cDOC,but NI was better in the dignosis of coma.Of course,a combination of BIS and NI to detect was more accurate in diagnosis of different consciouss state or coma than only one of them.But in the dignosis of cDOC,a combination of BIS and NI was better than NI and inferior to BIS.The BIS and GCS,which are the first assessment of the patients,were relevant to GOS.BIS was more correlate with GOS.Significantly higher BIS values were observed during the first recording for patients who had a good recovery as compared to patients with a bad recovery after 1 year.There was no statistical significance of the NI difference between the group with bad prognosis and another group with good prognosis.Conclusion:Narcotrend and BIS are objective evaluation tools in the dignosis of DOC,but also can be helpful in the prognosis of patients with DOC.First,BIS and NI can both distinguish the coma from cDOC,and BIS also can be used to disentangle VS from MCS.Second,BIS is more accurate in dignosis of cDOC,but NI is better at dignosis of coma.Third,a combination of BIS and NI to detect is more accurate in dignosis of coma than only one of them.But in the dignosis of cDOC,a combination of BIS and NI is better than NI and inferior to BIS.Fourth,BIS can help in the prognosis of the patients with DOC.