• Ayham Alkhachroum, Emilia Fló, Brian Manolovitz, Holly Cohan, Berje Shammassian, Danielle Bass, Gabriela Aklepi, Esther Monexe, Pardis Ghamasaee, Evie Sobczak, Daniel Samano, SaavedraAna BolañosABDivision of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA.Department of Neurology, Jackson Memorial Hospital, Miami, FL, USA., Nina Massad, Mohan Kottapally, Amedeo Merenda, Joacir Graciolli Cordeiro, Jonathan Jagid, Andres M Kanner, Tatjana Rundek, Kristine O'Phelan, Jan Claassen, and Jacobo D Sitt.
• Division of Neurocritical Care, Department of Neurology, University of Miami, 1120 NW 14th Street, Suite 1353, Miami, FL, USA. axa2610@med.miami.edu.
• Neurocrit Care. 2024 May 29.

BackgroundResting-state electroencephalography (rsEEG) is usually obtained to assess seizures in comatose patients with traumatic brain injury (TBI). We aim to investigate rsEEG measures and their prediction of early recovery of consciousness in patients with TBI.MethodsThis is a retrospective study of comatose patients with TBI who were admitted to a trauma center (October 2013 to January 2022). Demographics, basic clinical data, imaging characteristics, and EEGs were collected. We calculated the following using 10-min rsEEGs: power spectral density, permutation entropy (complexity measure), weighted symbolic mutual information (wSMI, global information sharing measure), Kolmogorov complexity (Kolcom, complexity measure), and heart-evoked potentials (the averaged EEG signal relative to the corresponding QRS complex on electrocardiography). We evaluated the prediction of consciousness recovery before hospital discharge using clinical, imaging, and rsEEG data via a support vector machine.ResultsWe studied 113 of 134 (84%) patients with rsEEGs. A total of 73 (65%) patients recovered consciousness before discharge. Patients who recovered consciousness were younger (40 vs. 50 years, p = 0.01). Patients who recovered also had higher Kolcom (U = 1688, p = 0.01), increased beta power (U = 1,652 p = 0.003) with higher variability across channels (U = 1534, p = 0.034) and epochs (U = 1711, p = 0.004), lower delta power (U = 981, p = 0.04), and higher connectivity across time and channels as measured by wSMI in the theta band (U = 1636, p = 0.026; U = 1639, p = 0.024) than those who did not recover. The area under the receiver operating characteristic curve for rsEEG was higher than that for clinical data (using age, motor response, pupil reactivity) and higher than that for the Marshall computed tomography classification (0.69 vs. 0.66 vs. 0.56, respectively; p < 0.001).ConclusionsWe describe the rsEEG signature in recovery of consciousness prior to discharge in comatose patients with TBI. rsEEG measures performed modestly better than the clinical and imaging data in predicting recovery.© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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