Serial multimodality-evoked potentials in severely head-injured patients

Objectives To assess the prognostic reliability of multimodality-evoked potentials and to evaluate the diagnostic implications and define the limits of these evoked potentials. Setting An ICU in a university hospital. Design Prospective clinical study. Patients Seventy-three severely head-injured patients aged 10 to 75 yrs. Methods Serial recording of brainstem auditory-evoked potentials and somatosensory-evoked potentials between days 1 and 21 after trauma. Comparison between evoked potential findings and prognosis, along with clinical data. Results Considering the single recordings of both brainstem auditory-evoked potentials and somatosensory-evoked potentials, the accuracy of prognostication in predicting a bad outcome was good only for severely abnormal brainstem auditory-evoked potentials. Serial brainstem auditory-evoked potential recordings and simultaneous recordings of brainstem auditory-evoked potentials and somatosensory-evoked potentials proved to be good prognostic indices in predicting a favorable outcome. Brainstem auditory-evoked potentials correlated well with brainstem reflexes and with pupil asymmetries but did not correlate with Glasgow Coma Scale scores. Conclusions Serial recording and the use of a multimodality approach provided the best prognostic capabilities. The main diagnostic implications were: a) the possibility of detecting brainstem compression by means of brainstem auditory-evoked potentials before the appearance of pupil abnormalities; b) the usefulness of brainstem auditory-evoked potentials in monitoring brainstem function in patients undergoing high-dose barbiturate therapy. Conclusions The main limitations of evoked potentials were the occurrence of peripheral acoustic damage, the electromagnetic sources of artifacts in the ICU, and the administration of ototoxic drugs.