Rehabilitation outcome of patients with severe and prolonged disorders of consciousness after aneurysmal subarachnoid hemorrhage (aSAH)

Clin Neurol Neurosurg. 2013 Oct;115(10):2136-41. doi: 10.1016/j.clineuro.2013.08.004. Epub 2013 Aug 12.

Abstract

Objectives: Our objectives were to evaluate rehabilitation outcome of aSAH survivors with severe disorders of consciousness (DOC) and to examine potential predictors of long-term outcome. Severe DOC includes patients in a vegetative state (VS) and in a minimally conscious state (MCS).

Patients and methods: This is a retrospective single-center cohort study of consecutive aSAH patients with severe and prolonged DOC upon admission to neurorehabilitation. Clinical assessments started right after discharge from ICU, a median of 26 days after the aSAH. Two different outcome criteria were used, one addressing the functional aspect (assessed by the Functional Independence Measure [FIM]) the other one addressing the level of consciousness ("behavioral outcome", assessed by the Coma Remission Scale [CRS]). Improved outcome was defined by an increase in FIM scores of at least 22 points (minimal clinically important difference) or by reaching a full score of 24 points on the CRS. Separate least square linear regression models were calculated to examine potential predictors for functional and behavioral outcome.

Results: Out of 63 patients, 19.0% and 39.7% of the patients achieved an improved functional and behavioral outcome, respectively. Age and level of consciousness upon admission to neurorehabilitation were independent prognostic factors for both outcome definitions. Both groups reached the better outcome category after a median of 11 and 9 weeks, respectively. In an individual patient, the longest delay to achievement of improved functional outcome was 30 weeks and to favorable behavioral outcome was 22 weeks after rehabilitation admission.

Conclusion: About one-third of severely affected aSAH patients with DOC regained at least a favorable behavioral status during early neurorehabilitation. It is interesting to note that in our study population, the beginning of clinical improvement took up to 6 months after aSAH.

Keywords: Aneurysmal subarachnoid hemorrhage; CRS; Clinical course; FIM; Functional Independence Measure; German version of the Coma Remission Scale; Neurorehabilitation; Outcome; Predicting outcome; Recovery of consciousness; SDH; VP shunt; VS; decannulation; decannulation of tracheostomy tube; infratentioral; infratentorial lesion; subdural hematoma; vegetative state at admission to neurorehabilitation; ventriculoperitoneal shunt.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Behavior
  • Cohort Studies
  • Coma / rehabilitation
  • Consciousness Disorders / etiology*
  • Consciousness Disorders / rehabilitation*
  • Female
  • Glasgow Outcome Scale
  • Humans
  • Length of Stay
  • Linear Models
  • Male
  • Middle Aged
  • Prognosis
  • Recovery of Function
  • Regression Analysis
  • Retrospective Studies
  • Subarachnoid Hemorrhage / complications*
  • Subarachnoid Hemorrhage / rehabilitation*
  • Treatment Outcome
  • Young Adult