Cognitive-motor dissociation and time to functional recovery in patients with acute brain injury in the USA: a prospective observational cohort study.
Cognitive-motor dissociation and time to functional recovery in patients with acute brain injury in the USA: a prospective observational cohort study.
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DOI：
10.1016/s1474-4422(22)00212-5
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发表时间：
2022-08
期刊：
影响因子：
48
通讯作者：
Claassen, Jan
中科院分区：
文献类型：
--
作者：
Egbebike, Jennifer;Shen, Qi;Doyle, Kevin;Der-Nigoghossian, Caroline A.;Panicker, Lucy;Gonzales, Ian Jerome;Grobois, Lauren;Carmona, Jerina C.;Vrosgou, Athina;Kaur, Arshnell;Boehme, Amelia;Velazquez, Angela;Rohaut, Benjamin;Roh, David;Agarwal, Sachin;Park, Soojin;Connolly, E. Sander;Claassen, Jan
临床无反应的急性脑损伤患者的恢复轨迹在很大程度上是不确定的。大脑响应口头运动指令的激活可以通过脑电图（EEG）来检测，也称为认知运动分离（CMD）。本文探讨CMD在预测急性脑损伤患者恢复时间中的作用。我们前瞻性研究了临床无反应的急性脑损伤患者的观察性队列（原始队列N=100，次要队列N=93）。将机器学习应用于脑电图记录，通过检测大脑对口头命令的激活来诊断CMD。在受伤后出院、3个月、6个月和12个月，用格拉斯哥结局量表（Glasgow Outcome Scale-Extended）评估功能结局。应用生存统计和移位分析来确定CMD与恢复时间和恢复程度之间的关联。我们的模型建立在原始队列的基础上，通过使用次要队列来确定预测精度。停用维持生命疗法的患者受到审查，死亡被视为一种竞争风险。12个月时，193例无反应患者中有28例（15%）GOS-E为4或以上。27例（14%）患者出现CMD，是较短恢复时间（HR5.6, 95%-CI 2.5-12.5）、潜在创伤性脑损伤（HR4.4, 95%-CI 1.4-14.0）、入院格拉斯哥昏迷量表评分大于或等于8 （HR2.2, 95%-CI 1.0-4.7）和较年轻（HR1.0, 95%-CI 1.0-1.1）的独立预测因子。在出院回家或进入康复机构的患者中，那些被诊断患有CMD的患者在受伤后3个月的功能恢复一直高于那些没有CMD的患者（or 4.5; 95%-CI 2.0-33.6）。脑损伤后早期诊断为CMD的临床无反应患者的恢复轨迹与未诊断为CMD的患者有明显差异。CMD的诊断可以为无反应患者的家庭提供更精确的咨询，并可能有助于确定从康复中受益的患者。国家卫生研究院NS106014， NS112760。
Recovery trajectories of clinically unresponsive patients with acute brain injury are largely uncertain. Brain activation in response to spoken motor commands can be detected by electroencephalography (EEG), also known as cognitive motor dissociation (CMD). Here we explore the role of CMD in predicting time to recovery in acutely brain injured patients. We prospectively studied an observational cohort of clinically unresponsive, acutely brain injured patients (original cohort N=100, secondary cohort N=93). Machine learning was applied to EEG recordings to diagnose CMD by detecting brain activation to verbal commands. Functional outcomes were assessed with the Glasgow Outcome Scale-Extended at hospital discharge, 3, 6, and 12 months after injury. Survival statistics and shift analyses were applied to identify an association between CMD and time to and magnitude of recovery. The prediction accuracy of our model built on the original cohort was determined using the secondary cohort. Patients that underwent withdrawal of life sustaining therapies were censored and death was treated as a competing risk. At 12 months, 28 of 193 (15%) unresponsive patients had a GOS-E of 4 or above. CMD was seen in 27 (14%) patients and was an independent predictor of shorter time to good recovery (HR5.6, 95%-CI 2.5–12.5), together with underlying traumatic brain injury (HR4.4, 95%-CI 1.4–14.0), admission Glasgow Coma Scale score greater or equal to 8 (HR2.2, 95%-CI 1.0–4.7), and younger age (HR1.0, 95%-CI 1.0–1.1). Amongst patients discharged home or to a rehabilitation setting, those diagnosed with CMD consistently had higher of functional recovery that those without CMD seen as early as 3 months after the injury (OR 4.5; 95%-CI 2.0–33.6). Recovery trajectories of clinically unresponsive patients diagnosed with CMD early after brain injury are distinctly different from those without CMD. Diagnosis of CMD may offer more precise counselling for families of unresponsive patients and potentially could help identify patients that benefit from rehabilitation. National Institute of Health NS106014, NS112760.