Do medical complications impact long-term outcomes in prolonged disorders of consciousness?

Publication date: Available online 26 May 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Anna Estraneo, Vincenzo Loreto, Orsola Masotta Psy, Angelo Pascarella, Luigi Trojano
Objectiveto investigate medical complications (MC) occuring within 6 months post-injury in brain-injured patients with prolonged disorders of consciousness (DoC) and to evaluate impact of MC on mortality and long-term clinical outcomes.Design: prospective observational cohort study.Setting: rehabilitation unit for acquired DoC.Partecipants194 patients with DoC (142 in vegetative state, 52 in minimally conscious state; traumatic etiology: 43, anoxic: 69, vascular: 82) consecutively admitted to a neurorehabilitation unit within 1-3 months after onset.Interventionsnot applicable.Main Outcome Measuresmortality and improvements in clinical diagnosis and functional disability level (assessed by Coma Recovery Scale-Revised and Disability Rating Scale) at 12, 24 and 36 months post-onset.Resultswithin 6 months post-injury, more than 95% of patients (188/194) developed at least 1 MC and 73% of them (142) showed at least 1 severe MC. Respiratory and musculoskeletal-cutaneous MC were the most frequent, followed by endocrino-metabolic abnormalities. Follow-up, complete in 189/194 patients, showed that male sex and endocrine-metabolic MC were associated to higher risk for mortality at all timepoints. Older age, anoxic etiology, lower CRS-R total scores and diagnosis of vegetative state at study entry predicted no clinical and functional improvements at most timepoints, whereas epilepsy predicted no improvement in diagnosis at 24 months post-onset only.ConclusionsMC are very frequent in patients with DoC within at least 6 months after brain injury, regardless of clinical diagnosis, etiology and age. Endocrino-metabolic MC are independent predictors of mortality at all timepoints, whereas epilepsy predicted poor long-term outcome. Occurrence and severity of MC in patients with DoC call for long-term appropriate levels of care after the post-acute phase.



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