[Effects of calorie information and nutrition traffic light on alimentation behaviour in public catering]. / Auswirkungen von Kalorienangaben und Ernährungsampel auf das Ernährungsverhalten in der Gemeinschaftsverpflegung.

BACKGROUND: Due to the significant increase in overweight and obese people, action is needed to raise eating behaviour awareness. A significant main meal (lunch) is witnessing a growing trend in the catering (part of the out-of-home nutrition). The aim of this study is to determine whether the selection of lunch menus is affected through the display of nutritional information in the form of number of calories or a traffic light model. METHODS: In this exploratory study, quantitative data were collected in a cross-sectional design. In addition to the established measurement instruments, socio-demographic and socio-economic information of the subjects based on the study were evaluated. The survey took place in 2008 in 2 passes (time t A/t B). The identical lunch menu of a catering company was applied twice respectively for 4 weeks. In the second run (t B) the lunch menu contained additional nutritional information (big 4 instructions) in the form of calories or a traffic light nutrition. The test of group differences was based on scientific statistical analysis in SPSS. RESULTS: The overall results for the illustration of kilocalories or traffic light do not have a unique significance in the direction of a low average number of calories at the time t B in comparison to the time t A. The food participants, on average, choose a lower calorie-containing menu, when a combination of traffic light and calories is given. CONCLUSION: The nutrition behaviour is accompanied by an oversupply of unhealthy foods. Lunch participants are sensitised for the selection of healthier lunch menus by a traffic light nutrition information or calories information. Nutrition labelling for lunch menus in the form of calories nutrition information or a coloured traffic light could trigger preventive effects.

[Evaluation of an established course of hospital management through structured telephone survey of former participants]. / Evaluierung eines etablierten Universitätslehrganges für Krankenhausmanagement durch telefonische Befragung ehemaliger Teilnehmer.

AIM OF THE STUDY: Participation in courses for health and hospital management is increasingly becoming a conditio sine qua non for candidates for executive positions in the health professions. The aim of this study was thus to evaluate the two-semester university course for health and hospital management offered by the University of Innsbruck since 1994. METHODS: A structured telephone survey was conducted to poll the participants (n = 184) of previous courses concerning time invested, cost-benefit ratio, quality of the course as well as implementation of course content. RESULTS: The university courses (n = 7) for health and hospital management of the University of Innsbruck evaluated in this study were rated in the upper half of the of the five-part scale (scores 2 to 3) for overall quality, cost-benefit ratio and implementation of course content. Only approx. 25 % of the course participants reported that the course had a positive influence on their career. The relatively high course fee was borne in part by the local hospital operator, a fact that had a certain influence on the selection of course participants. Participation in the course was largely made possible by exemptions from job duties (approx. 75 %) and to a lesser extent by vacation time (approx. 20 %) or time off for overtime (approx. 5 %). Of total absences from the course (3.18 +/- 3.41 d) 75 % was for job-related reasons, 6 % for illness and 19 % for other reasons. Overall, participants were absent more often, the larger the number of personnel in their department or clinic. CONCLUSION: All in all, the courses were considered important and recommendable, particularly with regard to communication, organization, time management and cost awareness. Streamlining (i. e. more content in less time), stronger practical orientation and a switch from mainly local to more international speakers would be important steps toward improving course quality. Thanks to its demonstrated quality, it can be said that the university course for health and hospital management held by the University of Innsbruck and evaluated in this study is certainly a worthwhile course offered in a still emerging market, namely one that will come under increasing pressure from the candidates for executive positions in the health professions to provide what is best for their careers and the health services industry in general.

[Value of a nutrition score in patients with advanced carcinomas in the area of the head and neck]. / Stellenwert eines Ernährungsscores bei Patienten mit fortgeschrittenen Karzinomen im Kopf-Hals-Bereich.

BACKGROUND AND OBJECTIVE: Patients with advanced head and neck cancer often suffer from malnutrition even before the start of therapy. Hence, the demand for nutritional support increases particularly before and during radiochemotherapy. Though nutritional therapy has been shown to substantially improve individual outcome, neither the criteria for patient candidacy nor the indications for therapeutic intervention have been established. We performed a retrospective analysis to determine the indications for nutritional support and < 0 evaluate the benefits of measures actually taken against malnutrition before and during radiochemotherapy as well as perioperatively. PATIENTS/METHODS: Data taken from a prospective study for the evaluation of oral mucositis during radiochemotherapy was analysed retrospectively. To calculate the indication for nutritional support, a nutritional scoring system (Hackl) was employed for the first time, which contained biochemical and anthropometric parameters as well as the period of starvation. The results were then compared to a nutritional support program implemented by the subjective examinations of the attending physician. RESULTS: Changes in body weight and body mass index (BMI) remained the most impressive parameters. Catabolic metabolism developed preoperatively and a significant loss of whole-body protein followed surgical therapy. Clinically, the results of the nutritional score correlated with the observation of malnutrition. Furthermore, our findings suggest that nutritional therapy was commonly delayed until late in the clinical course. CONCLUSION: The results indicate the necessity of objective and reproducible diagnosis and control of malnutrition. The scoring system used may provide a useful and yet simple tool for assessing individual indications for timely nutritional support.

[Implementing limited therapy methods in intensive care units: discontinuing therapy, reducing therapy and withholding therapy in intensive care units of the Innsbruck University Clinics]. / Durchführung therapielimitierender Massnahmen an Intensivmedizinischen Stationen: Therapieabbruch, Therapiereduktion und Therapieverzicht an den Intensivmedizinischen Abteilungen der Universitätskliniken Innsbruck.

INTRODUCTION: The intensive care physician is frequently confronted with the decision to withhold or withdraw therapy in patients with a poor prognosis. Apart from the legal implications, the practical management of withholding or withdrawing intensive care treatment continues to be indistinct. The subject has not been investigated in Austria or Germany. The aim of the study was to examine the different points of view of intensive care physicians and the various procedures to limit therapy in patients with a poor prognosis. METHODS: We interviewed physicians working at different intensive care departments of the University Hospital of Innsbruck from March to April 1998. RESULTS: Withholding treatment was given preference over withdrawing treatment. In regard of withdrawing treatment, 64% of the interviewed physicians felt more uncertain. In the decision making process the potential reversibility of disease was estimated to be more important than the wish of the patient. Hemofiltration and antibiotics were mentioned as the first measures the physicians would withdraw. The last measure that would be withheld was ventilatory support. Sixty-three per cent of the physicians felt that sedation and analgesia should be continued. In regard of withholding or withdrawing treatment 83% voted for an obligatory DNR order. CONCLUSION: Before withholding or withdrawing intensive care therapy, a medical specialist must determine and document the futile prognosis of the patient. If the patient's wish is unknown, all further decisions should be made in agreement with all participants. The goal of the therapy is to provide the patient maximum comfort under minimal intensive care treatment.

[Lipid infusion in multiple trauma intensive care patients in the early phase of treatment]. / Fettinfusion bei polytraumatisierten Intensivpatienten in der Frühphase der Behandlung.

OBJECTIVES: To study the metabolic effects of a high-dose fat infusion application in the early phase of total parenteral nutrition (TPN) after major trauma. DESIGN: Prospective study in male patients after major trauma. SETTING: Intensive care unit of the University Clinic. PATIENTS: 21 male, mechanically ventilated patients after major trauma. INTERVENTIONS: Infusion of Elolipid 20% (Fa. Leopold, Graz, Austria), starting on the 3rd day after ICU admission (0.075 g/kg body weight/h) in 8 h. The dose was increased on the 5th day (0.125 g/kg BW/h) and on the 7th day (0.15 g/kg BW/h). RESULTS: There was a pathologic rise in serum triglycerides on days 3, 5 and 7 during the infusion period. A serious diabetic metabolic state was shown on the 3rd day. No significant changes in urea production rate could be demonstrated after the high-dose fat infusion. CONCLUSIONS: The reason for the decreased fat elimination in patients after major trauma after high-dose fat infusion (8 h) remains unclear (fat clearance or fat oxidation failure). Therefore the fat infusion should be started after normalization of the blood glucose level. Thus the fat infusion should be given continuously over 24 h to avoid serious metabolic complications.

[Hypertriglyceridemia and acute pancreatitis]. / Hypertriglyzeridämie und akute Pankreatitis.

Data of 26 patients suffering from severe pancreatitis, who were treated at the anesthesiologic intensive care unit during the years 1991 and 1992, were evaluated with respect to etiologic factors, especially hypertriglyceridemia, stage of the disease and clinical outcome. Hypertriglyceridemia was found in 13 cases (11 men, 2 women, mean age 42 +/- 9 years) with values between 330 mg/dl and 4000 mg/dl. Lipid electrophoresis revealed a pattern typical for type IV hyperlipidemia. Insulin dependent diabetes was present in 4 patients and 5 reported about an unusual high alcohol intake preceding pancreatitis. Beside surgical approaches, including drainage and lavage, and basic intensive care treatment plasmapheresis was performed in 8 patients with hypertriglyceridemia. 5 patients with pancreatitis and hypertriglyceridemia died out of multiorganic failure, and so the mortality rate was 38%. The group of patients with pancreatitis caused by cholelithiasis or chronic alcohol consumption showed a mortality rate of 46%. The poor outcome of pancreatitis associated with hypertriglyceridemia demonstrates the importance of the treatment of hypertriglyceridemia in order to prevent the development of pancreatitis. The determination of plasma triglyceride values should belong to the routine diagnostic procedures in acute pancreatitis.

[Effects of short-term application of recombinant human growth hormone on urea production rate in patients in the early postoperative phase]. / Effekte einer kurzzeitigen Applikation von rekombinantem humanem Wachstumshormon auf die Harnstoffproduktionsrate von Patienten in der frühen postoperativen Phase.

OBJECTIVE: To determine the effect of short-term recombinant human growth hormone (rhGH) administration on urea production rate (UPR), N balance and aminograms. DESIGN: Prospective, double-blind placebo-controlled study. SETTING: Intensive care unit of a University Hospital. PATIENTS: 20 adult patients after major abdominal surgery. INTERVENTIONS: Postoperative substitution of rhGH (Saizen, Serono, Aubonne, CH) in a dose of 0.15 IE/kg BW for 3 days. The serum levels of hGH, insulin-like growth factor-1 (IGF-1), ACTH and cortisol were measured as well as the amino acids in plasma. The degree of catabolism was calculated according to Woolfson's formula, which is based on the UPR, and by calculation of the cumulative N balance. RESULTS: With exception of proline, the plasma amino acids between the groups receiving active substance and total parenteral nutrition (TPN) and those receiving placebo and TPN did not differ significantly. Neither was there a significant difference between the groups for any other parameter measured. The UPR and IGF-1 levels showed only a tendency towards higher values as compared with the placebo group (UPR verum group, values in g/day: 1st measurement, 29.8 +/- 16.7; 2nd measurement, 28.3 +/- 17.7; 3rd measurement, 32.1 +/- 19.1; 4th measurement, 33.1 +/- 21.2. UPR placebo, values in g/day; 1st measurement, 32.6 +/- 23.9; 2nd measurement, 30.8 +/- 17.9; 3rd measurement 41.6 +/- 28.7; 4th measurement, 47.3 +/- 29.5. IGF-1 verum group, values in nmol/l; 1st measurement, 25.7 +/- 19.2; 2nd measurement, 44.8 +/- 23; 3rd measurement, 52.4 +/- 30; 4th measurement, 54.3 +/- 20. IGF-1 placebo, values in nmol/l; 1st measurement: 22.9 +/- 11.7; 2nd measurement, 37.0 +/- 19.4; 3rd measurement, 38.4 +/- 21.4; 4th measurement, 40.0 +/- 23.0). The ACTH-cortisol axis was only slightly depressed in the group receiving active substance. CONCLUSIONS: We conclude that short-term rhGH administration over 3 days is not capable of significantly reducing the UPR in postoperative patients, but we cannot exclude a significant difference between rhGH group and placebo after a longer administration period.

Noise in the ICU.

OBJECTIVE: The growing number of technical devices in ICUs makes noise exposure a major stressor. The purpose of this study was to assess noise levels during routine operation in our ICU. DESIGN: Our ICU is an open ward with four rooms, constructed in the 1960s. During the study period, 4 patients were in the controlled room and were treated by 4 nurses during the day and by 2 at night. A-weighted sound pressure levels (SPL) were measured continuously for 2 days and nights. Also measured were the alarms of various appliances. For gross overall evaluation it is customary to state the Leq, i.e. the energy-averaged level during measurement. The annoyance caused by noise depends more on rare events of high intensity. Therefore, the distribution of SPL values (Ln) over time was also analysed. RESULTS: SPL was roughly the same during the day and at night, with Leq between 60-65 dB(A) and peaks up to 96 dB(A). Most alarms reach an SPL of 60-70 dB(A), but some exceed 80 dB(A). During teaching rounds Leq exceeds 65 dB(A). CONCLUSION: During the day and at night SPL always surpasses the permissible noise exposure for 24 h of 45 db(A) recommended by the US Environmental Protection Agency. Alarms cause the most irritating noise. Hospital management should pay attention to internal noise, and SPL should be measured routinely.

Atrial natriuretic peptide (ANP), aldosterone, angiotensin II and renin in the 'low T3 syndrome' in organ donors.

The present prospective study was conducted in order to investigate the effect of an acute decrease in serum T3 levels on ANP, aldosterone, angiotensin II, renin and ADH. All patients showed a pathologic TRH stimulation test prior to organ harvesting. Our patients developed secondary T3 hypothyroidism of different severity dependent on intensive care unit (ICU) stay. T3 values in group 1 (ICU stay > or = 77 h) were smaller than 70 ng/dl, those of group 2 (ICU stay < or = 53 h) were greater than 70 ng/dl. In both groups a severe elevation of plasma renin activity was measured, with almost high-normal values for ANP in group 1 and slightly elevated values in group 2 [not significant (n.s.)]. Results demonstrate that, contrary to patients who are not critically ill, brain-dead patients develop a dissociation of the renin-angiotensin-aldosterone mechanism. No statistical significant difference was found between the groups in serum levels of ADH and aldosterone. This endocrine dissociation, however, seems to have no clinical significance with regard to organ function after transplantation in kidney recipients.

Factors influencing transcutaneous oxygen and carbon dioxide measurements in adult intensive care patients.

Transcutaneous PO2 (PtcO2) is suggested to reflect tissue oxygenation in intensive care patients, whereas transcutaneous PCO2 (PtcCO2) is advocated as a noninvasive method for assessing PaCO2. In 24 critically ill adult patients (mean Apache II score 14.2, SD 4.7) we investigated the impact of variables that are commonly thought to determine PtcO2 and PtcCO2 measurements. A linear correlation was found between PtcO2 and PaO2 (r = 0.6; p less than or equal to 0.0001) and between PtcO2 and mean arterial blood pressure (MAP; r = 0.42; p less than or equal to 0.003). Cardiac index (CI) correlated with tc-index (PtcO2/PaO2; r = 0.31; p less than or equal to 0.03). There was no relationship between PtcO2 and hemoglobin concentration (Hb) and the position of the oxygen dissociation curve (ODC). Stepwise multiple regression analysis demonstrated a significant influence of PaO2 and MAP on PtcO2. The contribution of CI, Hb and the ODC was not significant. Only 40% of the variability of a single PtcO2 measurement could be explained by PaO2 and MAP. A significant linear correlation was demonstrated between PtcCO2 and PaCO2 (r = 0.76; p less than or equal to 0.0001) but not between PtcCO2 and CI, MAP and arterial base excess (BEa). Stepwise multiple regression analysis revealed an influence of PaCO2 and of CI on PtcCO2; 66% of the variability of a single PtcCO2-value could be explained by PaCO2 and CI. Our data demonstrate that transcutaneous derived gas tensions result from complex interaction between hemodynamic, respiratory and local factors, which can hardly be defined in ICU-patients.

Endocrine abnormalities in severe traumatic brain injury--a cue to prognosis in severe craniocerebral trauma?

Patients with severe craniocerebral trauma (sCCT) display metabolic and endocrine changes. The question is raised whether hormonal patterns give cues to the prognosis of outcome or not. In 21 patients the function of the adrenocortical, gonadal, thyroid and human growth hormone (hGH)-insulin system was assessed. LH, FSH, TSH, prolactin and hGH were stimulated. 3 groups of patients were formed. Group I: patients in acute phase with a Glasgow Coma Score (GCS) more than 6 (group Ia) and less than 6 (group Ib). Group II: patients in transition to traumatic apallic syndrome (TAS). Group III: patients with full-blown or resolving TAS. The values of group Ia comprised low T3, T4 and testosterone, elevated insulin, normal hGH. Group Ib had hypothyroid T3 and T4 and an attenuated response of LH, TSH, prolactin and hGH to stimulation. Group III: there was seen an endocrine normalisation with elevated T4 and TBG and an altered response of hGH and prolactin to stimulation. Endocrine abnormalities were not helpful in predicting which course, either to better or to worse, a given patient would follow.

[Myoglobin release and renal function in polytraumatized patients in intensive care]. / Myoglobinfreisetzung und Nierenfunktion bei polytraumatisierten Intensivpatienten.

The excessive release of myoglobin following extensive skeletal muscle trauma, burns, and myopathies may result in renal dysfunction. Due to its molecular size, myoglobin is filtered through the glomerulus and is in part reabsorbed by the tubular system. intraluminal deposition of myoglobin following renal hypoperfusion and the impact of endogenous mediators on cell function contribute to the pathogenesis of acute renal failure. The present study was aimed to investigate the relation between myoglobin and renal function in polytraumatized patients. Thirty-four patients with an Injury Severity Score (ISS) of 28 +/- 3.1 (SEM) and a mean age of 39.5 years (range 18-70) were studied prospectively. Myoglobin, sodium, and creatinine concentrations in plasma and urine were determined 8-hourly. Myoglobin excretion, fractional myoglobin excretion, myoglobin clearance, creatinine clearance, and fractional excretion of sodium were calculated. The mean concentration of plasma myoglobin on the 1st day post-trauma was 3087 ng/ml. A continuous decrease in plasma myoglobin concentration could be observed, with a mean value of 497 ng/ml on day 7. The myoglobin concentration in urine showed marked fluctuations: the mean values were 3.37-4.12 mg/ml on day 1 and 0.78-1.34 mg/ml on day 7. There was no correlation between plasma and urine myoglobin concentrations. The myoglobin concentration increased during the period of observation, but there was no correlation with the creatinine clearance. The fractional excretion of myoglobin was in the range of 1% to 14%. There was no correlation between the fractional excretions of myoglobin and sodium.(ABSTRACT TRUNCATED AT 250 WORDS)

The secretion of human growth hormone stimulated by human growth hormone releasing factor following severe cranio-cerebral trauma.

Patients suffering from severe cranio-cerebral trauma show alterations of the secretory patterns of thyroid stimulating hormone (TSH) and human growth hormone (HGH) which may be of prognostic significance. We studied 10 patients following severe brain injury and prospectively compared a new synthetic human growth hormone releasing factor (HGHRF) test with the thyrotropin releasing hormone (TRH) test. On admission, all patients had a Glasgow Coma Scale score of 3 or 4. All patients had a low T3 syndrome. In the patients who died the TSH response after stimulation with TRH was also absent. In the patients who survived a significant TSH increase was observed (p less than 0.05). In comparison to the patients who died those who survived showed a significant (p less than 0.001) HGH increase after HGHRF stimulation. This test might be useful as an additional tool in establishing early prognosis in patients with severe brain injury.

[Differentiated enteral feeding in the post-aggression phase in polytrauma patients. Comparison of a high calorie nutritionally defined diet (whole protein high calorie diet) with a peptide diet]. / Differenzierte enterale Ernährung in der Postaggressionsphase bei Polytraumatisierten. Vergleich einer hochkalorischen nährstoffdefinierten Diät (WPHC-Diät) mit einer Peptid-Diät.

Two groups of 10 patients with an identical mean injury score (25 + 5) were treated from day 3 after injury until day 10 with a whole protein high caloric (WPHC) diet (group A) or with a peptide diet (PD) (group B). Intake of calories, protein, water, Na+ and K+ was measured daily as well as excretion of urine, Na+ and K+. Gastric reflux, bowel movement and plasma levels of Na+ and K+ were registered and the nitrogen balance and Na+/K+ quotient in urine were calculated daily. Clinically both diets were well tolerated, with low gastric reflux and no diarrhea. The calculated caloric demand could be covered in group A on day 7 post-injury (or day 4 of enteral nutrition) and in group B on day 11 post-injury (or day 7 of enteral nutrition). The caloric intake in group A remained significantly higher on days 4-10. There was no difference in nitrogen balance. Total enteral Na+ and fluid intake were significantly lower in group A, but some additional parenteral Na+ had to be given to keep plasma Na+ levels in the normal range. There was no difference in urine output between the 2 groups; therefore, there was a significant fluid retention in group B. Interestingly, the Na+/K+ quotient in urine was significantly higher in group A. The low Na+ intake might influence the back flow of interstitial edema in the 'flow phase'. This diet seems to be adequate, especially for the nutrition of burn patients and of patients with cardiac disease, and can cover the high caloric needs of polytraumatised patients within a few days.

Effect of prolonged sedation with propofol on serum triglyceride and cholesterol concentrations.

We compared changes in serum lipid concentrations in ICU patients receiving a 3-day continuous infusion of propofol with those in patients receiving conventional sedation. No adverse effects were observed and the serum lipid concentrations were not significantly influenced by propofol. It is concluded that propofol might be a suitable agent for long-term sedation in the ICU, although serum lipid concentrations should be monitored throughout its administration.

[The malignant neuroleptic syndrome and malignant hyperthermia]. / Malignes Neurolept Syndrom und maligne Hyperthermie.

We report on a patient with neuroleptic malignant syndrome (NMS) caused by a therapy for endogenous depression. The symptoms were hyperpyrexia (39.2 degrees C), rigidity, elevated creatine kinase (CK: 594 U/l) and coma. After transfer from an outside hospital, he was treated, at first without effect with dantrolene p.o. (80 mg q.i.d.) and i.v. (1 mg/kg-1/h-1). Clinical improvement and temperature reduction were noted when the levels of neuroleptic drugs fell during unspecific intensive care with mechanical ventilation, sedation (flunitrazepam, barbiturates), relaxation (pancuronium), and hydration. After uncomplicated weaning from the ventilator the patient became more cooperative and was returned to the psychiatric ward. Further treatment took the form of combined drug therapy with biperiden and flunitrazepam and in addition a series of 12 electroconvulsive therapies (ECT). The elevated CK levels initially decreased, serum potassium levels were found to be within normal limits, and myoglobinuria was not detected during the further course. Trigger agents for NMS are antipsychotic drugs such as thioxanthenes, phenothiazines and butyrophenones. Because the signs and symptoms are so similar to those of malignant hyperthermia (MH), it has been suggested that NMS and MH are related diseases. The postulated mechanisms of NMS become apparent in the CNS, whereas those of MH affect the muscle cell itself. An abnormal in vitro contraction test after NMS should suggest to triggering of MH crisis after succinylcholine administration in anaesthesia for ECT.(ABSTRACT TRUNCATED AT 250 WORDS)

[Energy demands and supply in polytraumatized patients in the postoperative phase]. / Energiebedarf und -deckung bei polytraumatisierten Patienten in der postoperativen Phase.

Normal enteral feeding cannot be maintained after trauma. Post-aggression metabolism or socalled "flow phase" usually results from hormonal changes, including rise in catecholamine and cortisole, drop in testosterone as well as T3 and T4, and relative hGH deficit. Glucose intolerance, increased demand for energy, and catabolism are the consequences along with reduced protein uptake and increased protein breakdown with all associated complications. Indirect calorimetry is an important method to determine energy requirements and, above all, is used to monitor nutrition and other therapeutic interventions. Substrate requirement and distribution of substrate supplies are discussed in some detail. All-in-one solutions and tube feeding have quite often proved helpful in providing patients with sufficient and properly adapted nutrition. On top of adequate nutrition, catabolism is therapeutically controlled by medication, using beta-blockers and hGH. The need for supervision of nutrition is also discussed.

Central somatosensory conduction time and acoustic brainstem transmission time in post-traumatic coma.

Short-latency evoked potentials (SEPs) of the scalp and neck after median nerve stimulation and acoustic brainstem evoked potentials (BAEPs) were recorded in 85 patients in post-traumatic coma with clinical signs of brainstem impairment between days 2 and 6 after trauma. The central somatosensory conduction time (CCT), the amplitude ratio (AR) N20:N13, the interpeak latencies (IPL) I-III, III-V, I-V, and the ARs between waves I and V (I:V) and between wave I and the wave IV/V complex (I:IV/V) were calculated and related to the outcome of the patients. In cases of coma due to supratentorial lesions, CCT and ARs of SEPs were close to normal in patients with good outcome: CCT increased and ARs decreased with worsening of outcome. In cases of primary brainstem injury, a significant prolongation of CCT was also seen in patients with good recovery, whereas normal CCTs could be found in patients with severe disability and death outcome. In this case, unilateral absent scalp SEPs were frequently found. The IPLs I-III, III-V, I-V, and the ARs of BAEPs increased with worsening of outcome. Significant differences of IPL I-V and III-V (brainstem transmission time) were seen between patients with good recovery or moderate disability outcome and the patients with severe disability or death outcome. There was no difference in BAEPs between patients with primary brainstem lesion and patients with secondary brainstem lesion. Patients with bilateral absent SEPs and bilateral absent BAEPs not related to traumatic or preexisting hearing disorders died or survived severely disabled. Unilateral absence of scalp SEPs and unilateral absence of BAEPs were frequently found in patients who died or who had severe disability. Asymmetries in scalp SEPs appeared to be distributed equally to all outcome categories, but asymmetries in BAEPs increased with worsening of outcome too. In most of the patients who died or survived disabled, both SEPs and BAEPs were abnormal.