Evidence map›Paper›PMID 26156112›Full record

Observational studyNeurocritical care2016

Multi-Center Study of Diffusion-Weighted Imaging in Coma After Cardiac Arrest.

K G Hirsch, M Mlynash, I Eyngorn, R Pirsaheli, A Okada, S Komshian, C Chen, S A Mayer, J F Meschia, R A Bernstein and 4 more

Abstract readMulticenter StudyObservational Study
PubMed Publisher
In one paragraph

Observational study in Neurocritical care, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 3 pooled it
5.3field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 3 syntheses or guidelines pooled it, 73 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 8 institutions in 1 country.

K G HirschStanford Stroke and Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford University School of Medicine, Stanford, CA, USA. kghirsch@yahoo.com.
M MlynashStanford Stroke and Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford University School of Medicine, Stanford, CA, USA.
I EyngornStanford Stroke and Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford University School of Medicine, Stanford, CA, USA.
R PirsaheliStanford Stroke and Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford University School of Medicine, Stanford, CA, USA.
A OkadaStanford University Oncology Division, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
S KomshianStanford Stroke and Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford University School of Medicine, Stanford, CA, USA.
C ChenDepartment of Neurology, Sutter Pacific Medical Foundation, San Francisco, CA, USA.
S A MayerMount Sinai Healthcare System, Departments of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
J F MeschiaDepartment of Neurology, Mayo Clinic Florida, Jacksonville, FL, USA.
R A BernsteinDavee Department of Neurology, Feinberg School of Medicine of Northwestern University, Northwestern University, Chicago, IL, USA.
O WuDepartment of Radiology, Athinoula A Martinos Center, Massachusetts General Hospital, Boston, MA, USA.
D M GreerDepartment of Neurology, Yale School of Medicine, Yale University, New Haven, CT, USA.
C A WijmanStanford Stroke and Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford University School of Medicine, Stanford, CA, USA.
G W AlbersStanford Stroke and Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford University School of Medicine, Stanford, CA, USA.
Stanford University · USAthinoula A. Martinos Center for Biomedical Imaging · USCalifornia Pacific Medical Center · USMayo Clinic in Florida · USMount Sinai Health System · USNorthwestern University · USStanford Medicine · USYale University · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe ability to predict outcomes in acutely comatose cardiac arrest survivors is limited. Brain diffusion-weighted magnetic resonance imaging (DWI MRI) has been shown in initial studies to be a simple and effective prognostic tool. This study aimed to determine the predictive value of previously defined DWI MRI thresholds in a multi-center cohort.

methodsDWI MRIs of comatose post-cardiac arrest patients were analyzed in this multi-center retrospective observational study. Poor outcome was defined as failure to regain consciousness within 14 days and/or death during the hospitalization. The apparent diffusion coefficient (ADC) value of each brain voxel was determined. ADC thresholds and brain volumes below each threshold were analyzed for their correlation with outcome.

results125 patients were included in the analysis. 33 patients (26%) had a good outcome. An ADC value of less than 650 × 10(-6) mm(2)/s in ≥10% of brain volume was highly specific [91% (95% CI 75-98)] and had a good sensitivity [72% (95% CI 61-80)] for predicting poor outcome. This threshold remained an independent predictor of poor outcome in multivariable analysis (p = 0.002). An ADC value of less than 650 × 10(-6) mm(2)/s in >22% of brain volume was needed to achieve 100% specificity for poor outcome.

conclusionsIn patients who remain comatose after cardiac arrest, quantitative DWI MRI findings correlate with early recovery of consciousness. A DWI MRI threshold of 650 × 10(-6) mm(2)/s in ≥10% of brain volume can differentiate patients with good versus poor outcome, though in this patient population the threshold was not 100% specific for poor outcome.

Indexed as

Outcome Assessment, Health CareAdultAgedBrainBrain DeathComaDiffusion Magnetic Resonance ImagingFemaleHeart ArrestHumansMaleMiddle AgedRetrospective StudiesCardiac arrestComaDWIMRIPrognosis

Identifiers

PMID26156112
OpenAlexW839598313

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.