Standardized visual EEG features predict outcome in patients with acute consciousness impairment of various etiologies
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RESEARCH
Standardized visual EEG features predict outcome in patients with acute consciousness impairment of various etiologies Michael Müller1, Andrea O. Rossetti2, Rebekka Zimmermann1, Vincent Alvarez3, Stephan Rüegg4, Matthias Haenggi5, Werner J. Z’Graggen6,7, Kaspar Schindler1 and Frédéric Zubler1*
Abstract Background: Early prognostication in patients with acute consciousness impairment is a challenging but essential task. Current prognostic guidelines vary with the underlying etiology. In particular, electroencephalography (EEG) is the most important paraclinical examination tool in patients with hypoxic ischemic encephalopathy (HIE), whereas it is not routinely used for outcome prediction in patients with traumatic brain injury (TBI). Method: Data from 364 critically ill patients with acute consciousness impairment (GCS ≤ 11 or FOUR ≤ 12) of various etiologies and without recent signs of seizures from a prospective randomized trial were retrospectively analyzed. Random forest classifiers were trained using 8 visual EEG features—first alone, then in combination with clinical features—to predict survival at 6 months or favorable functional outcome (defined as cerebral performance category 1–2). Results: The area under the ROC curve was 0.812 for predicting survival and 0.790 for predicting favorable outcome using EEG features. Adding clinical features did not improve the overall performance of the classifier (for survival: AUC = 0.806, p = 0.926; for favorable outcome: AUC = 0.777, p = 0.844). Survival could be predicted in all etiology groups: the AUC was 0.958 for patients with HIE, 0.955 for patients with TBI and other neurosurgical diagnoses, 0.697 for patients with metabolic, inflammatory or infectious causes for consciousness impairment and 0.695 for patients with stroke. Training the classifier separately on subgroups of patients with a given etiology (and thus using less train‑ ing data) leads to poorer classification performance. Conclusions: While prognostication was best for patients with HIE and TBI, our study demonstrates that similar EEG criteria can be used in patients with various causes of consciousness impairment, and that the size of the training set is more important than homogeneity of ACI etiology. Keywords: Electroencephalography, Prognostication, Acute consciousness impairment, Hypoxic ischemic encephalopathy, Traumatic brain injury, Random forest
*Correspondence: [email protected] 1 Department of Neurology, Sleep‑Wake‑Epilepsy‑Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Full list of author information is available at the end of the article
Background Outcome prediction in patients with acute consciousness impairment (ACI) in the intensive care unit is essential in order to inform the relatives and avoid futile treatment [1, 2]. Prognostication is based on clinical and paraclinical examinations including blood tests, neuroimaging and electrophysiology [3]. The
© The Author(s) 2020. Open Access This article is license
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