Accuracy of clinical signs, SEP, and EEG in predicting outcome of hypoxic coma A meta-analysis

Lee, Y.C., Phan, T.G., Jolley, D.J., Castley, H.C., Ingram, D.A. and Reutens, D.C. (2010) Accuracy of clinical signs, SEP, and EEG in predicting outcome of hypoxic coma A meta-analysis. Neurology, 74 7: 572-580. doi:10.1212/WNL.0b013e3181cff761

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Author Lee, Y.C.
Phan, T.G.
Jolley, D.J.
Castley, H.C.
Ingram, D.A.
Reutens, D.C.
Title Accuracy of clinical signs, SEP, and EEG in predicting outcome of hypoxic coma A meta-analysis
Journal name Neurology   Check publisher's open access policy
ISSN 0028-3878
Publication date 2010-02-16
Sub-type Article (original research)
DOI 10.1212/WNL.0b013e3181cff761
Volume 74
Issue 7
Start page 572
End page 580
Total pages 9
Place of publication Hagerstown, MD, U.S.A.
Publisher Lippincott Williams & Wilkins
Collection year 2011
Language eng
Formatted abstract
Accurate prediction of neurologic outcome after hypoxic coma is important. Previous systematic reviews have not used summary statistics to summarize and formally compare the accuracy of different prognostic tests. We therefore used summary receiver operating characteristic curve (SROC) and cluster regression Methods to compare motor and pupillary responses with sensory evoked potential (SEP) and EEG in predicting outcome after hypoxic coma.

We searched PubMed, MEDLINE, and Embase (1966-2007) for reports in English, German, and French and identified 25 suitable studies. An SROC was constructed for each marker (SEP, EEG, M1 and M≤3), and the area under the curve (AUC), a measure of diagnostic accuracy, was determined. For comparison, we calculated the differences between the AUC for each test and M1 reference standard.

The AUC for absent SEP was larger than those for M1, M≤3, absent pupillary response, and EEG when the examinations were performed within the first 24 hours. The difference between the AUC for SEP (AUC 0.891) and that for M1 (AUC 0.786) was small (0.105, 95% confidence interval 0.023-0.187), only reaching significance on day 1 after coma onset. The use of M≤3 improved the diagnostic accuracy of motor signs.


This study demonstrated that sensory evoked potential (SEP) is marginally better than M1 at predicting outcome after hypoxic coma. However, the superiority of SEP diminishes after day 1 and when M≤3 is used. The findings therefore caution against the tendency to generalize that SEP is a better marker than clinical signs. © 2010 by AAN Enterprises, Inc.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
Centre for Advanced Imaging Publications
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Citation counts: TR Web of Science Citation Count  Cited 17 times in Thomson Reuters Web of Science Article | Citations
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Created: Tue, 22 Feb 2011, 14:38:29 EST by Sandrine Ducrot on behalf of Centre for Advanced Imaging