Gianfranco Lamberti (Italy)
E. Viglietta Neurorehabilitation and Vegetative State UnitAuthor Of 1 Presentation
INTERNATIONAL PROSPECTIVE STUDY ON LONG-TERM CLINICAL EVOLUTION OF PATIENTS WITH SEVERE BRAIN INJURY AND DISORDERS OF CONSCIOUSNESS
- Anna Estraneo (Italy)
Abstract
Background and Aims:
The present international prospective longitudinal study, promoted by the Special Interest Group on DoC of the International Brain Injury Association (IBIA), was aimed at identifying clinical and neurophysiologic predictors for 24-month clinical outcome and mortality in patients with prolonged disorders of consciousness (pDoC).
Methods:
Twelve specialized centres enrolled patients in Vegetative State (VS) or in Minimally Conscious State (MCS) within 3 months from acquired brain injury. Patients were followed up to 24 months post-injury for data collection on mortality and clinical improvement (i.e. from VS to MCS, and from VS or MCS to full consciousness).
Results:
24-month outcome data was available for 55 traumatic and 88 non-traumatic patients (VS=68, 19 females; MCS=75, 22 females). At 24 months post-onset, 41/143 patients (28.7%) had died, with higher mortality in VS (42.6%) than in MCS (16%; p<.001). Baseline significant predictors of mortality at multivariate Cox regression were older age and lower Coma Recovery Scale-Revised total score in VS, and female sex and absence of alpha rhythm on EEG in MCS. At the 24-month evaluation, 77 patients (54%; 26 VS) had improved their state of consciousness and 66 (46%; 42 VS) did not. Multivariate logistic regression showed that shorter time post-injury and presence of alpha rhythm on EEG in VS (24/66 improved), and male sex in MCS (47/68 improved) significantly predicted clinical improvement.
Conclusions:
A bedside multimodal assessment could provide valuable information for prognostication in patients with pDoC. These findings can help clinicians and families navigate complex caring and decision-making.