Patterns of Use of Somatosensory Evoked Potentials for Comatose Patients in Canada

Abstract Purpose To measure how frequently somatosensory evoked potentials (SEPs) are used in comatose patients after traumatic brain injury (TBI) and hypoxic ischemic encephalopathy (HIE), how SEPs contribute to outcome prediction and clinical decision-making, and how available they are to clinicia...

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Bibliographic Details
Published in:Journal of critical care 2016-12, Vol.36, p.130-133
Main Authors: Robinson, Lawrence R., MD, Chapman, Martin, BM, Schwartz, Michael, MD, MSc, Bethune, Allison J., MSc, Potapova, Ekaterina, BSc, Strauss, Rachel, Scales, Damon C., MD, PhD
Format: Article
Language:English
Subjects:
Brain Injuries, Traumatic - complications
Brain Injuries, Traumatic - diagnosis
Brain Injuries, Traumatic - physiopathology
Canada
Clinical Decision-Making
Clinical medicine
Coma
Coma - diagnosis
Coma - etiology
Coma - physiopathology
Confidence intervals
Cost control
Critical Care
Decision making
Evoked Potentials, Somatosensory - physiology
Glasgow Coma Scale
Health sciences
Humans
Hypoxia-Ischemia, Brain - complications
Hypoxia-Ischemia, Brain - diagnosis
Hypoxia-Ischemia, Brain - physiopathology
Hypoxic ischemic encephalopathy
Intensive care
Magnetic Resonance Imaging
Neurologists
Neurosurgeons
Physicians
Polls & surveys
Practice Patterns, Physicians
Prognosis
Somatosenory-evoked potentials
Studies
Surveys and Questionnaires
Traumatic brain injury
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Summary:Abstract Purpose To measure how frequently somatosensory evoked potentials (SEPs) are used in comatose patients after traumatic brain injury (TBI) and hypoxic ischemic encephalopathy (HIE), how SEPs contribute to outcome prediction and clinical decision-making, and how available they are to clinicians. Methods A novel factual and scenario-based survey instrument to measure patterns of SEPs use in comatose patients due to HIE or TBI was distributed to critical care, neurology, and neurosurgical physicians across Canada. The analysis was based on 86 completed surveys from specialists in neurology (36), neurosurgery (24), and critical care (22). Results The majority (73%) of respondents reported that SEPs were available. When provided clinical vignettes, only 36% indicated that they would use them in TBI and 49% would use them in HIE. When respondents ranked the various methods available for establishing prognosis for awakening, SEP was ranked after cerebral blood flow and MRI. The majority did not accurately estimate chances of awakening when SEP responses were bilaterally absent. Conclusions There are significant opportunities to optimize the use of SEPs in comatose patients including: standardizing SEP testing and reporting; better communicating results to critical care physicians; and improving the understanding regarding the recommended use and interpretation of these tests.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2016.07.003