Continuous electroencephalography predicts delayed cerebral ischemia after subarachnoid hemorrhage: A prospective study of diagnostic accuracy.
Continuous electroencephalography predicts delayed cerebral ischemia after subarachnoid hemorrhage: A prospective study of diagnostic accuracy.
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DOI：
10.1002/ana.25232
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发表时间：
2018-05
影响因子：
11.2
通讯作者：
Westover MB
中科院分区：
文献类型：
--
作者：
Rosenthal ES;Biswal S;Zafar SF;O'Connor KL;Bechek S;Shenoy AV;Boyle EJ;Shafi MM;Gilmore EJ;Foreman BP;Gaspard N;Leslie-Mazwi TM;Rosand J;Hoch DB;Ayata C;Cash SS;Cole AJ;Patel AB;Westover MB
迟发性脑缺血（DCI）是蛛网膜下腔出血（SAH）常见的致残性并发症。预防DCI是神经重症监护的重点，但干预措施具有风险，不能不加区别地应用。虽然回顾性研究已经确定了与DCI相关的连续EEG（cEEG）测量，但没有任何研究能够以足够的严格性表征cEEG的准确性，以证明使用它来将患者分类到干预或临床试验是合理的。因此，我们前瞻性地评估了cEEG预测DCI的准确性，遵循诊断准确性研究报告标准。我们前瞻性地在一家机构对非创伤性、高度SAH患者进行了cEEG检查。索引测试由临床神经生理学家前瞻性报告预先规定的EEG警报组成：1）相对α变异性降低，2）α-δ比值降低，3）局灶性减慢恶化，或4）迟发性癫痫样异常。诊断参考标准是通过盲法、裁定审查确定的DCI。主要结局指标为cEEG对后续DCI的敏感性和特异性，通过多状态生存分析确定，并根据基线风险进行调整。227例连续患者中有103例合格并接受了cEEG监测（平均持续时间为7.7天）。96.2%的患者发生EEG报警，19.6%的患者未发生后续DCI（中位潜伏期为1.9天[IQR 0.9-4.1]）。在警报亚型中，晚发性癫痫样异常具有最高的预测价值。预先规定的EEG结果预测低（91%灵敏度，83%特异性）和高（95%灵敏度，77%特异性）基线风险患者的DCI。连续EEG准确预测SAH后的DCI，并可能有助于对继发性脑损伤风险最高的患者进行靶向治疗。
Delayed cerebral ischemia (DCI) is a common, disabling complication of subarachnoid hemorrhage (SAH). Preventing DCI is a key focus of neurocritical care, but interventions carry risk and cannot be applied indiscriminately. While retrospective studies have identified continuous EEG (cEEG) measures associated with DCI, no study has characterized the accuracy of cEEG with sufficient rigor to justify using it to triage patients to interventions or clinical trials. We therefore prospectively assessed the accuracy of cEEG for predicting DCI, following the Standards for Reporting Diagnostic Accuracy Studies. We prospectively performed cEEG in non-traumatic, high-grade SAH patients at a single institution. The index test consisted of clinical neurophysiologists prospectively reporting pre-specified EEG alarms: 1) decreasing relative alpha variability, 2) decreasing alpha-delta ratio, 3) worsening focal slowing, or 4) late-appearing epileptiform abnormalities. The diagnostic reference standard was DCI determined by blinded, adjudicated review. Primary outcome measures were sensitivity and specificity of cEEG for subsequent DCI, determined by multi-state survival analysis, adjusted for baseline risk. 103 of 227 consecutive patients were eligible and underwent cEEG monitoring (7.7-day mean duration). EEG alarms occurred in 96.2% of patients with and 19.6% without subsequent DCI (1.9-day median latency [IQR 0.9–4.1]). Among alarm subtypes, late-onset epileptiform abnormalities had the highest predictive value. Pre-specified EEG findings predicted DCI among patients with low (91% sensitivity, 83% specificity) and high (95% sensitivity, 77% specificity) baseline risk. Continuous EEG accurately predicts DCI following SAH, and may help target therapies to patients at highest risk of secondary brain injury.
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影响因子：
6
作者：
Dorhout Mees SM;Kerr RS;Rinkel GJ;Algra A;Molyneux AJ
通讯作者：
Molyneux AJ
影响因子：
2.1
作者：
Joly, P;Commenges, D;Letenneur, L
通讯作者：
Letenneur, L
影响因子：
9.9
作者：
CHATRIAN, GE;SHAW, CM;LUTTRELL, CN
通讯作者：
LUTTRELL, CN
影响因子：
1.4
作者：
Randò, T;Ricci, D;Guzzetta, F
通讯作者：
Guzzetta, F
Stard 2015：用于报告诊断准确性研究的基本项目的更新列表。
DOI：
10.1136/bmj.h5527
发表时间：
2015-10-28
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Bossuyt PM;Reitsma JB;Bruns DE;Gatsonis CA;Glasziou PP;Irwig L;Lijmer JG;Moher D;Rennie D;de Vet HC;Kressel HY;Rifai N;Golub RM;Altman DG;Hooft L;Korevaar DA;Cohen JF;STARD Group
通讯作者：
STARD Group