Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies

Brain Inj. 2021 Jan 5;35(1):1-7. doi: 10.1080/02699052.2020.1861652. Epub 2020 Dec 17.

Abstract

Aim: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state- MCS) and in different etiologies..Design: Multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury.Main Measures: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications.Results: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology.Conclusion: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.

Keywords: Disorders of consciousness; clinical complexity; medical complications; neurorehabilitation; outcome.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Brain Injuries*
  • Consciousness Disorders / etiology
  • Consciousness*
  • Cross-Sectional Studies
  • Humans
  • Persistent Vegetative State / etiology