Use of the Bispectral Index to Predict Recovery of Consciousness in Patients with Spontaneous Intracerebral Hemorrhage After Surgical Hematoma Evacuation: A Prospective Cohort Study

Abstract

Background Our study aimed to test the predictive value of the bispectral index (BIS) for the post-operational consciousness recovery in patients undergone hematoma evacuation due to spontaneous intracerebral hemorrhage (ICH). Material/Methods In this prospective cohort study, we enrolled adult spontaneous ICH patients after surgical hematoma evacuation who did not recover consciousness on the first postoperative day. After patient enrollment, the BIS was continuously monitored for 12 hours, and the motor response on the Glasgow Coma Scale (GCS-M) was evaluated. The patients were followed up for 30 days and divided into a consciousness recovery group and a nonrecovery group. Receiver operating characteristic curve analysis was performed to investigate the predictive values of the BIS, GCS-M and ICH score on the consciousness recovery. The area under the curve (AUC) and 95% confidence interval (95%CI) were calculated. During the 12-hour monitoring period, the peak BIS value after GCS-M stimulation was used for ROC analysis. Results Of the 55 enrolled patients, 19 patients recovered consciousness, and 36 patients did not. The BIS value of the consciousness recovery group was significantly higher than that of the nonrecovery group ( P <0.001). For consciousness recovery prediction, the AUC (95%CI) of the BIS values after external stimulation was 0.97 (0.91–1.00), which was superior to the GCS-M (0.75 [0.59–0.91]) and ICH score (0.57 [0.41–0.73]). Conclusions Our study demonstrates that BIS might be a potential tool for predicting the consciousness recovery in ICH patients undergone surgical hematoma evacuation.

Bispectral Index in predicting in‐hospital mortality in patients with ischemic stroke: A methodological study

“…12,28 And finally, a lot of researchers have investigated the predictive performances of BIS scoring for neurological outcome or mortality in different clinical conditions such as after brain injury and other comatose patients in the last decades. 10,15–17,21,29,30 Dou et al 10 found that BIS values >42.5 were correlated with the prognosis of comatose patients in ICU. Fabregas et al 16 studied a model relating BIS to the probability of recovery of consciousness in patients with severe brain injury.…”

“…In a recent study, the researchers investigated the predictive value of the BIS for the post-operational consciousness recovery and they showed that it might be a potential tool for predicting the consciousness recovery in intracerebral hemorrhage patients undergoing hematoma evacuation. 29…”

“…After that, the association between BIS index and the depth of coma had been studied in head injured or other comatose patients 12 , 28 . And finally, a lot of researchers have investigated the predictive performances of BIS scoring for neurological outcome or mortality in different clinical conditions such as after brain injury and other comatose patients in the last decades 10 , 15–17 , 21 , 29 , 30 . Dou et al 10 found that BIS values >42.5 were correlated with the prognosis of comatose patients in ICU.…”

“…In a recent study, the researchers investigated the predictive value of the BIS for the post-operational consciousness recovery and they showed that it might be a potential tool for predicting the consciousness recovery in intracerebral hemorrhage patients undergoing hematoma evacuation. 29 GCS are commonly used to evaluate the patient's neurological status in ICU. 11 It is also used to prognostic model in patients with brain injury and other comatose clinical conditions in ED.…”

“…They demonstrated that an abnormal BIS trace, defined as either a persistently low BIS and/or electroencephalographic burst suppression not explained by hypnotic drug administration or hypothermia, was strongly associated with poor neurological outcome. In a recent study, the researchers investigated the predictive value of the BIS for the post‐operational consciousness recovery and they showed that it might be a potential tool for predicting the consciousness recovery in intracerebral hemorrhage patients undergoing hematoma evacuation 29 …”