Predicting coma and other low responsive patients outcome using event-related brain potentials: A meta-analysis

Objective A meta-analysis was performed to estimate the predictive power (odd ratio, OR) for awakening of auditory event-related potential (ERP) components in low responsive patients with stroke or hemorrhage, trauma, anoxic, post-operative, and metabolic encephalopathy etiologies. Methods We reviewed MEDLINE and analyzed citations for retrieved articles. Logistic regressions were applied on patient samples (Glasgow Coma Scale <12) across and for separate etiologies. Results For stroke and hemorrhage the ORs with 95% confidence intervals were: 2.05 [1.12–3.75] (N100), 4.47 [1.92–10.44] (MMN), 10.29 [2.00–52.79] (P300), for trauma: 1.63 [0.70–3.80] (N100), 4.72 [1.35–16.44] (MMN), 12.89 [4.82–34.43] (P300), anoxic: 8.03 [2.83–22.75] (N100), 15.50 [4.27–56.26] (MMN), 5.93 [2.38–14.77] (P300), post-operative: 10.66 [1.98–57.50] (N100), metabolic encephalopathy: 2.12 [0.34–13.13] (N100), 3.60 [0.28–46.36] (MMN), 7.71 [0.75–79.77] (P300), and all etiologies: 2.85 [1.91–4.27] (N100), 6.53 [3.55–12.01] (MMN), and 8.79 [4.88–15.83] (P300). Based on six N100 studies (N = 548 patients), five MMN studies (N = 470), and six P300 studies (N = 313), the N100, MMN, or P300, when present, significantly predicted awakening, P300 and MMN being significantly better predictors than N100. Conclusions The MMN and P300 appear to be reliable predictors of awakening. Significance The prognostic assessment of low responsive patients with auditory ERP should take into account both MMN and P300.