Can behavioural observations made during the SMART assessment detect the potential for later emergence from vegetative state?

ABSTRACT

The management of prolonged disorders of consciousness (PDOC) such as vegetative state (VS) is a major clinical challenge. Presently there are no validated prognostic markers for emergence from VS apart from age, aetiology and time spent in VS. This study explores whether or not the behavioural observation component of the SMART assessment can detect the potential for later emergence from VS. For this retrospective study 14 patients were selected who were originally assessed by the SMART as being in VS. Clinical records showed that seven of these patients have since emerged from VS (Group 1) and the other half have remained in VS (Group 2). The number, type and frequency of behaviours observed during the first five and the last five sessions of the SMART assessment were compared between the groups. The results suggest that the patients who emerged exhibited a significantly higher number of different behaviour types than those who remained in VS (p = .045). Finding an accurate predictor of prognosis for emergence from VS would assist in optimising the treatment and cost-effective management of this population in the future. Since this is a small sample the results should be reviewed with some caution but they suggest that the patients who later emerge from VS can be differentiated behaviourally from those who remain in VS.

KEYWORDS:

• Prolonged disorders of consciousness
• vegetative state
• outcome
• recovery
• prognosis