Evidence map›Paper›PMID 31242361›Full record

ArticleThe New England journal of medicine2019

Detection of Brain Activation in Unresponsive Patients with Acute Brain Injury.

Jan Claassen, Kevin Doyle, Adu Matory, Caroline Couch, Kelly M Burger, Angela Velazquez, Joshua U Okonkwo, Jean-Rémi King, Soojin Park, Sachin Agarwal and 5 more

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In one paragraph

Article in The New England journal of medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 252 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
252citing papers in PubMed, 4 pooled it
34.3field-weighted citation impact, top 1% 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

252 citing papers in PubMed, 4 syntheses or guidelines pooled it, 497 citations in OpenAlex.

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  18. Resting-state EEG for continuous prognostic monitoring and prediction of coma recovery after acute brain injury.Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology · 2026
    Article
  19. Covert brain complexity in the intensive care unit.Cortex; a journal devoted to the study of the nervous system and behavior · 2026
    Article
  20. Article

192 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 2 institutions in 1 country.

Jan ClaassenFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Kevin DoyleFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Adu MatoryFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Caroline CouchFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Kelly M BurgerFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Angela VelazquezFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Joshua U OkonkwoFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Jean-Rémi KingFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Soojin ParkFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Sachin AgarwalFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
David RohFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Murad MegjhaniFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Andrey EliseyevFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
E Sander ConnollyFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.
Benjamin RohautFrom the Departments of Neurology (J.C., K.D., A.M., C.C., K.M.B., A.V., J.U.O., S.P., S.A., D.R., M.M., A.E., B.R.) and Neurosurgery (E.S.C.), Columbia University, and the Department of Psychology, New York University (J.-R.K.) - both in New York.ORCID 0000-0001-6752-8756
Columbia University · USNew York University · US

Funding

Dana Foundation Clinical Neuroscience Research Program
6 · The paper itself

Abstract

backgroundBrain activation in response to spoken motor commands can be detected by electroencephalography (EEG) in clinically unresponsive patients. The prevalence and prognostic importance of a dissociation between commanded motor behavior and brain activation in the first few days after brain injury are not well understood.

methodsWe studied a prospective, consecutive series of patients in a single intensive care unit who had acute brain injury from a variety of causes and who were unresponsive to spoken commands, including some patients with the ability to localize painful stimuli or to fixate on or track visual stimuli. Machine learning was applied to EEG recordings to detect brain activation in response to commands that patients move their hands. The functional outcome at 12 months was determined with the Glasgow Outcome Scale-Extended (GOS-E; levels range from 1 to 8, with higher levels indicating better outcomes).

resultsA total of 16 of 104 unresponsive patients (15%) had brain activation detected by EEG at a median of 4 days after injury. The condition in 8 of these 16 patients (50%) and in 23 of 88 patients (26%) without brain activation improved such that they were able to follow commands before discharge. At 12 months, 7 of 16 patients (44%) with brain activation and 12 of 84 patients (14%) without brain activation had a GOS-E level of 4 or higher, denoting the ability to function independently for 8 hours (odds ratio, 4.6; 95% confidence interval, 1.2 to 17.1).

conclusionsA dissociation between the absence of behavioral responses to motor commands and the evidence of brain activation in response to these commands in EEG recordings was found in 15% of patients in a consecutive series of patients with acute brain injury. (Supported by the Dana Foundation and the James S. McDonnell Foundation.).

Indexed as

ElectroencephalographySupport Vector MachineAdultAgedArea Under CurveBrainBrain InjuriesCognitionFemaleGlasgow Coma ScaleGlasgow Outcome ScaleHumansIntensive Care UnitsMaleMiddle AgedMotor Activity

Identifiers

PMID31242361
OpenAlexW2955728019

What OpenQuestion holds

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Registered trials

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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.