Predictive efficiency of auditory mismatch negativity on consciousness recovery at 6 months after severe traumatic brain injury
Objective To explore the predictive efficiency of auditory mismatch negativity(MMN)on consciousness recovery at 6 months after severe traumatic brain injury(sTBI).Methods A retrospective case-control study was conducted to analyze the clinical data of 51 patients with sTBI admitted to Xiangya Hospital of Central South University from May 2021 to June 2023,including 38 males and 13 females,aged 18-70 years[54.0(42.0,62.0)years].The Glasgow coma scale(GCS)score was 3-5 points in 37 patients and 6-8 points in 14.All the patients were monitored by MMN within 7-27 days after injury.Based on the Glasgow prognostic scale(GOS)score at 6 months after injury,the patients were divided into recovered consciousness group(GOS 3-5 points,21 patients)and unrecovered consciousness group(GOS 1-2 points,30 patients).The data of the two groups were recorded,including gender,age,cause of injury,pupillary light reflex and GCS under MMN monitoring,absolute amplitude of N1 at Fz under standard stimulus(sFzN1A),absolute amplitude of N1 at Fz under the deviant stimulus(dFzN1A),absolute amplitude of N1 at Cz under standard stimulus(sCzN1A),absolute amplitude of N1 at Cz under the deviant stimulus(dCzN1A),absolute value of MMN amplitude at Fz(FzMMNA),and absolute value of MMN amplitude at Cz(CzMMNA).The independent predictors of consciousness recovery in sTBI patients at 6 months after injury were assessed and determined by univariate analysis and multivariate binary Logistic regression analysis.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the efficacy of each independent predictor in predicting consciousness recovery in sTBI patients and determine the cut-off values.Results Univariate analysis revealed that the pupillary light reflex and GCS under MMN monitoring,and the FzMMNA were significantly correlated with the consciousness recovery(P＜0.05 or 0.01).Multivariate binary Logistic regression analysis showed that GCS score under MMN monitoring(OR=9.07,95％CI 1.93,42.76,P＜0.01)and absolute FzMMNA(OR=2.74,95％CI 1.13,6.65,P＜0.05)were significantly correlated with the consciousness recovery of sTBI patients at 6 months after injury.The ROC curve analysis showed that FzMMNA had a relatively higher predictive efficiency(AUC=0.76,95％CI 0.62,0.90),followed by GCS score under MMN monitoring(AUC=0.74,95％CI 0.59,0.88).Certainly,the combination of both presented the highest predictive efficiency(AUC=0.84,95％CI 0.73,0.95).Inaddition,with 1.0 μV as the cut-off value,the sensitivity and specificity of FzMMNA＞1.0 μV were 66.7％and 80.0％in predicting consciousness recovery.Conclusion FzMMNA is the independent predictor of consciousness recovery at 6 months after sTBI and its predictive efficiency for consciousness recovery is even higher when combined with GCS.
Coma,post-head injuryConsciousness disordersGlasgow coma scaleMismatch negativity
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