Bedside exams often miss subtle signs that patient is 'awake,' study says
By Robert Preidt
THURSDAY, July 20, 2017 (HealthDay News) -- Sophisticated brain scans might be able to detect consciousness in brain injury patients who appear unconscious in the intensive care unit, a new study says.
"Early detection of consciousness and brain function in the intensive care unit could allow families to make more informed decisions about the care of loved ones," said study co-lead author Dr. Brian Edlow. He's with Massachusetts General Hospital's Center for Neurotechnology and Neurorecovery.
"Also, since early recovery of consciousness is associated with better long-term outcomes, these tests could help patients gain access to rehabilitative care once they are discharged from an ICU," Edlow said in a hospital news release.
The study included 16 severe brain injury patients in the ICU. The researchers concluded that functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) may reveal a level of consciousness that can't be detected by the standard bedside neurological examination.
There are several reasons why the standard bedside exam may wrongly indicate that a patient is unconscious. The patient may be unable to speak, write or move due to the brain injury itself or sedating medications, or the doctor may misinterpret a weak but intentional movement as a reflex response, the study authors noted.
Previous research has suggested that up to 40 percent of conscious brain injury patients are mistakenly classified as unconscious, the researchers pointed out.
While previous studies used fMRI or EEG to detect consciousness in brain injury patients who have moved from hospitals to rehabilitation or nursing care facilities, this is the first such study to be conducted in ICU patients, according to the researchers.
"Much more work needs to be done to determine the utility of these techniques for detecting consciousness in patients with severe traumatic brain injuries," said Edlow, who is also an assistant professor of neurology at Harvard Medical School.
"Based on these results, our team ... is working on improving the accuracy of these tests, and we are planning a larger follow-up study in the near future," he said.
The study was published July 20 in the journal Brain.
The U.S. National Institute of Neurological Disorders and Stroke has more on traumatic brain injury.
SOURCE: Massachusetts General Hospital, news release, July 20, 2017
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