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

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
• medical complications
• clinical complexity
• neurorehabilitation
• outcome

Acknowledgments

This study has been devised by the Special Interest Group on acquired brain injury and DoC (ABI & DoC SIG) of the Italian Society of Neurological Rehabilitation (SIRN, see http://www.sirn.net). The authors would like to thank dr. Aloise Marta and dr. Corallo Francesco who participated in the study for their help with data collection. A special acknowledgement is for Dott. Marco Sarà and Dr Maria Chiara Carboncini, died prematurely this year, who collected data for this study in the San Raffaele Post-Coma Rehabilitative Unit of Cassino and in sABI section, Integrated Care Dept of Medical Specialties, AO-Universitaria Pisana of Pisa, respectively.

Declaration of interest statement

The authors report no conflicts of interest.

Data availability statement

The data that support the findings of this study are available from the corresponding author [AE ([email protected])], upon reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.