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J Korean Soc Emerg Med > Volume 21(5); 2010 > Article
Journal of The Korean Society of Emergency Medicine 2010;21(5): 628-636.
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.
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.
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.
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.
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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