Outcome. Hence, GWR only marginally increased sensitivity for poor outcome detection in a prediction approach that requires only one positive parameter.Scheel et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:23 http://www.sjtrem.com/content/21/1/Page 4 of1.4 1.3 1.2 1.1 1.0 0.9 0.8 0.7 1 2 3 CPC 4Figure 1 Association of GWR with outcome. Median and interquartile range are shown. Circles denote individual patients. No patient with GWR < 1.16 had CPC 1? while 38 of patients with CPC 3? had GWR < 1.16.Predicting poor outcome if both, NSE > 97 g/L and SSEP bilaterally absent, yielded a sensitivity of 43 . With this approach (at least two parameters pathologic for prediction of poor outcome), GWR increased sensitivity to 53 . Table 4 gives an overview of prediction by NSE, SSEP and GWR for the subgroup of patients (n = 62) for which all three parameters were available.GWRGWR cut-off value and timing of CCTOur cut-off value of 1.16 is similar to previously published values. Torbey et al. found a GWR < 1.18 to be 100 specific of poor outcome [11]. The authors obtained GWR at the basal ganglia level in normothermic patients. None of the eleven patients with GWR < 1.18 survived. In the largest cohort so far by Metter et al., a GWR < 1.15 was found to be 100 specific for poor outcome [17]. CCTTable 2 Absolute attenuation in Hounsfield Units and GWR calculationsGood outcome (CPC 1?) n = 37 CN PU THL CC PIC MC1 MC2 MWM1 MWM2 GWR-AV GWR-BG GWR-CE 33.7 (32.5?5.1) 34.7 (33.7?6.1) 32.9 (31.2?4.3) 27.5 (26.6?8.3) 27.4 (26.2?8.5) 31.6 (30.8?2.7) 31.5 (30.3?2.2) 25.9 (24.1?7.2) 25.9 (24.3?6.7) 1.24 (1.21?.27) 1.26 (1.23?.29) 1.22 (1.17?.28) Poor outcome (CPC 3?) n = 61 31.3 (28.1?3.2) 32.8 (30.1?4.7) 31.1 (29.5?2.8) 26.7 (25.7?8.7) 27.7 (26.5?9.0) 29.5 (28.2?2.3) 29.4 (27.5?0.7) 25.8 (24.3?7.3) 26.0 (24.3?7.3) 1.18 (1.10?.22) 1.18 (1.10?.25) 1.17 (1.10?.20) p-value MWU test < 0.001 < 0.001 0.002 0.241 0.459 < 0.001 < 0.001 0.860 0.514 < 0.001 < 0.001 < 0.Discussion Our study suggests that a gray-whitematter ratio (GWR) below 1.16 may be a specific parameter for prediction of poor outcome in patients treated with hypothermia. This corroborates previous findings that were obtained in normothermia and mixed patient cohorts (normothermia and hypothermia). None of 23 patients with a GWR < 1.16 survived with good outcome. The majority of patients with GWR < 1.16 had at least one other parameter indicative of poor Nelfinavir (Mesylate) outcome (NSE > 97 g/L and/or bilateral absent SSEP). Therefore, GWR did not substantially increase the sensitivity for poor outcome detection, if one accepts poor PubMed ID:https://www.ncbi.nlm.nih.gov/pubmed/16989806 outcome prediction by a single parameter. However, because individual patients may survive despite poor outcome prediction by single parameters, it has been argued that poor outcome prediction should be based on a multi-parameter approach [6]. We demonstrated in a subgroup of 62 patients who had received NSE, SSEP and CCT that a GWR < 1.16 increased the sensitivity of poor outcome detection (from 43 (17/40) to 53 (n = 21/40)) if at least two pathologic test results were required for poor outcome prediction. These results suggest that GWR is a useful additional parameter that may increase the level of certainty for poor outcome prediction in comatose patients after cardiac arrest.The table shows Median (IQR) for each group and the respective p-value of the Mann-Whitney-Utest. Caudate nucleus-CN, putamen-PU, thalamus-THL, CCcorpus callosum, posterior lim.