• Siena Duarte, Ze Ou, Mingfeng Cao, Sung-Min Cho, Nitish V Thakor, Eva K Ritzl, and Romergryko G Geocadin.
• Department of Neurology - Division of Neurocritical Care, University of California, San Francisco. Electronic address: siena.duarte@ucsf.edu.
• Resuscitation. 2024 Aug 24: 110377110377.

BackgroundSomatosensory evoked potentials (SEPs) are highly specific predictors of poor prognosis in hypoxic-ischemic coma when cortical responses (N20s) are absent. However, bilateral N20 presence is nonspecific for good outcomes. High-frequency oscillations (HFOs) in the SEP waveform predict neurologic recovery in animals, but clinical applications are poorly understood. We sought to develop a clinical measure of HFOs to potentially improve detection of good outcomes in coma.Materials And MethodsWe collected SEP waveform data from all comatose inpatients (GCS<=8) who underwent neurologic prognostication from 2020-2022 at Johns Hopkins Hospital. We developed a novel measure - HFO evoked to spontaneous ratios (HFO-ESRs) - and applied this to those patients with bilaterally present N20s using both standard univariate classification and cubic kernal vector machine (SVM) models to predict the last documented in-hospital Glasgow Coma Scale (GCS) prior to discharge or death.ResultsOf 58 total patients, 34 (58.6%) had bilaterally present N20s. Of these, 14 had final GCS>=9, and 20 had final GCS<=8. Mean age was 52 (+/- 17) years, 20.1% female. Etiologies of coma were primarily global hypoxic-ischemic brain injury (79.4%), intracranial hemorrhage (11.8%), and traumatic brain injury (2.9%). In univariate classification, the addition of averaged HFO-ESRs to present N20s predicted final GCS>=9 with 68% specificity. The SVM model further improved specificity to 85%.ConclusionsIn this pilot investigation, we developed a novel clinical measure of SEP HFOs. Incorporation of this measure may improve the specificity of the SEP to predict in-hospital GCS outcomes in coma, but requires further validation in specific neurologic injuries and with longitudinal outcomes.Copyright © 2024. Published by Elsevier B.V.

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