Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies. (5th January 2021)

• Record Type: Journal Article
• Authors: Estraneo, A; Masotta, O; Bartolo, M; Pistoia, F; Perin, C; Marino, S; Lucca, L; Pingue, V; Casanova, E; Romoli, A; Gentile, S; Formisano, R; Salvi, GP; Scarponi, F; De Tanti, A; Bongioanni, P; Rossato, E; Santangelo, A; Diana, AR; Gambarin, M; Intiso, D; Antenucci, R; Premoselli, S; Bertoni, M; De Bellis, F
• Is Part Of: Brain injury. Volume 35:Number 1(2021)
• Page Start: 1
• Page End: 7
• Publication Date: 2021-01-05
• Subjects: Disorders of consciousness -- medical complications -- clinical complexity -- neurorehabilitation -- outcome; Brain damage -- Periodicals; Brain -- Wounds and injuries -- Periodicals; Brain Injuries -- Periodicals; 617.481
• DOI: 10.1080/02699052.2020.1861652
• Languages: English
• ISSNs: 0269-9052

Abstract

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.