A Tree of Life? Multivariate logistic outcome-prediction in disorders of consciousness

Autor: Johanna Kissler, Inga Steppacher, Fridtjof W. Nussbeck, Peter Fuchs, Michael Kaps
Rok vydání: 2019
Předmět:
Adult
Male
030506 rehabilitation
Multivariate statistics
Adolescent
Consciousness
genetic structures
Neuroscience (miscellaneous)
Disorders of consciousness
Outcome (game theory)
behavioral disciplines and activities
Young Adult
03 medical and health sciences
0302 clinical medicine
Developmental and Educational Psychology
medicine
Humans
Evoked Potentials
Aged
unresponsive wakefulness syndrome
N100
business.industry
Electroencephalography
Cognition
consciousness state
logistic outcome-prediction
Middle Aged
Prognosis
medicine.disease
N400
Logistic Models
Treatment Outcome
Multivariate Analysis
Etiology
Consciousness Disorders
Female
Neurology (clinical)
0305 other medical science
business
minimal
030217 neurology & neurosurgery
Predictive modelling
psychological phenomena and processes
Clinical psychology
Popis: Background: Currently, the clinical outcome of patients with very severe head injuries and subsequent chronic disorders of consciousness is seen as generally very poor. Here, we specify individual outcome chances for disorders of consciousness (DOC) patients on the basis of clinical and EEG data and identify different subgroups of DOC patients, who vary substantially regarding their outcome chances. Methods: We employed data from 102 patients with DOC and used standard clinical protocol data (age, etiology, diagnosis, gender) and early sensory (N100, Mismatch Negativity) and late cognitive (P300, N400) EEG event related potentials (ERPs) to predict patients recovery rates. Results: Two significant prediction models emerged: In both, subgroups of patients with good (51%, tree 1) to very good recovery chances (97%, tree 2) could be identified. The first model was obtained from standard clinical data. The second model included late cognitive ERPs (N400 and P300) and resulted in considerably better patient classification. Moreover, when taking cognitive event related potentials into account, the standard protocol data did not add further significant information, neither did early ERPs (N100, MMN). This highlights that cognitive ERPs provide decisive information about an individual patient’s prognosis. Conclusion: The presented information about outcome chances of individual disorders of consciousness patients will be vital for these patients and critical for clinical professionals who have to direct specialized treatments and council relatives. Legal guardians and families, in turn, need to know what to expect in the future in order to prepare for the challenges ahead. Keywords: Disorders of consciousness, Unresponsive wakefulness syndrome, Minimal consciousness state, Logistic outcome-prediction.
Databáze: OpenAIRE
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