| The Utility of Bispectral Index Scores for Sedative Intoxication in the Emergency Department |
| Hyen Kyeng Sung, Sung Youp Hong, Jang Young Lee, Young Mo Yang, Gyeong Nam Park, Hee Bum Yang, Jung Kyu Park, Hwa Yeon Yi |
1Department of Emergency Medicine, College of Medicine, Eulji University, Deajeon, Korea. pons1224@eulji.ac.kr
2Department of Emergency Medicine, Gumi Gangdong Hospital, Gumi, Korea.
3Department of Emergency of Medical Services Technology, Deajeon Health Sciences College, Deajeon, Korea. |
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| ABSTRACT |
PURPOSE:
This study was designed to determine the utility of bispectral index scores (BIS) compared to Glasgow coma scale (GCS) or Observer's Assessment of Alertness/Sedation Scale (OAA/S), in measuring changes in consciousness, prognosis and management of sedative-intoxication patients.
METHODS:
Sedative intoxication patients, who came to the emergency department with a severe deficit in consciousness, or a GCS less than 12, were analyzed. Patients' consciousness states were evaluated using OAA/S and GCS and compared with BIS scores. Patients' consciousness recovery time and hospitalization were recorded to see if these could be predicted by BIS using regression analysis. BIS, OAS/S and GCS were compared with regard to intubation, admission and ICU admission. Furthermore, usefulness and cut-off values of BIS were evaluated for those intubated.
RESULTS:
Of 128 sedative intoxication patients, 32 were enrolled for this study. Mean age was 50.94+/-18.01. They took 20.76+/-16.95 times over the average recommended dose.
OAA/S and GCS ranged between 1~4 and 4~12, respectively; BIS was 39~88. The Spearman bivariate correlation coefficient was 0.619 between OAA/S and BIS and 0.651 between GCS and BIS, both showing a positive correlation (p<0.001). The coefficient of determination between BIS and recovery time was 0.182 and was statistically significant (Recovery time = -0.321xBIS+34.806) (p=0.015). However, admission, ICU admission and hospitalization were not significant (p>0.05).
BIS was an effective index for intubation (p=0.012) showing a sensitivity of 91% and a specificity of 50% when the boundary value was set to 65.5. When set to 77.5, sensitivity and specificity were 59%, 100%, respectively.
CONCLUSION:
In sedative intoxication patients, BIS is useful in determining the degree of sedation, predicting time to recovery of consciousness and as an objective index of intubation. |
| Key words:
Consciousness monitors, Poisoning, Hypnotics and sedatives, Glasgow coma scale, Emergencies |
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