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Auditory evoked potentials in coma after closed head injury

A clinical-neurophysiologic coma scale for predicting outcome

Departments of Neurology (Dr. Karnaze) and Medicine (Dr. Weiner), USC School of Medicine, Los Angeles, CA; and the Division of Neurosurgery (Dr. Marshall), University of California at San Diego, San Diego, CA.

We studied auditory evoked potentials in 45 head-injured patients. All but three were comatose or stuporous at the time of study. Preservation of brainstem auditory or long-latency auditory evoked potentials predicted good outcome. The Glasgow coma scale (GCS), the clinical subtotal of the neurophysiologic coma scale (NPCS), and the NPCS had predictive accuracies of 71%, 82%, and 82%. Although there were 22 falsely pessimistic predictions with the GCS and 9% with the clinical subtotal of the NPCS, there were no falsely pessimistic predictions with the NPCS.

Address correspondence and reprint requests to Dr. Karnaze, USC School of Medicine, Department of Neurology, 2025 Zonal Avenue, Room 5641, Los Angeles, CA 90033.

Presented in part at the thirty-sixth annual meeting of the American Academy of Neurology, Boston, MA. April 1984.

Accepted for publication November 30, 1984.