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KMID : 0385920100210050628
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Journal of the Korean Society of Emergency Medicine
2010 Volume.21 No. 5 p.628 ~ p.636
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The Utility of Bispectral Index Scores for Sedative Intoxication in the Emergency Department
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Sung Hyeon-Kyeng
Hong Sung-Youp
Lee Jang-Young
Yang Young-Mo
Park Gyeong-Nam
Yang Hee-Bum
Park Jung-Kyu
Yi Hwa-Yeon
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Abstract
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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 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 = -0.321×BIS+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.
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KEYWORD
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Consciousness monitors, Poisoning, Hypnotics and sedatives, Glasgow coma scale, Emergencies
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