Do Medical Complications Impact Long-Term Outcomes in Prolonged Disorders of Consciousness?

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Abstract

OBJECTIVE: To investigate medical complications (MCs) occurring within 6 months postinjury 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.

PARTICIPANTS: Patients (N=194) with DoC (142 in vegetative state [VS], 52 in minimally conscious state; traumatic etiology 43, anoxic 69, vascular 82) consecutively admitted to a neurorehabilitation unit within 1-3 months postonset.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Mortality and improvements in clinical diagnosis and functional disability level (assessed by Coma Recovery Scale-Revised [CRS-R] and Disability Rating Scale) at 12, 24, and 36 months postonset.

RESULTS: Within 6 months postinjury, 188 of 194 patients (>95%) developed at least 1 MC and 142 of them (73%) showed at least 1 severe MC. Respiratory and musculoskeletal-cutaneous MCs were the most frequent, followed by endocrino-metabolic abnormalities. Follow-up, complete in 189 of 194 patients, showed that male sex and endocrine-metabolic MCs were associated with higher risk of mortality at all timepoints. Old age, anoxic etiology, lower CRS-R total scores, and diagnosis of VS at study entry predicted no clinical and functional improvements at most timepoints; however, epilepsy predicted no improvement in diagnosis at 24 months postonset only.

CONCLUSIONS: MCs are very frequent in patients with DoC within at least 6 months after brain injury, regardless of clinical diagnosis, etiology, and age. Endocrino-metabolic MCs are independent predictors of mortality at all timepoints; however,epilepsy predicted poor long-term outcome. Occurrence and severity of MCs in patients with DoC call for long-term appropriate levels of care after the postacute phase.

Original languageEnglish
Pages (from-to)2523-2531.e3
JournalArchives of Physical Medicine and Rehabilitation
Volume99
Issue number12
DOIs
Publication statusPublished - Dec 2018

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Consciousness Disorders
Persistent Vegetative State
Mortality
Coma
Epilepsy
Subacute Care
Brain Injuries
Observational Studies
Blood Vessels
Cohort Studies
Rehabilitation
Skin
Brain

Cite this

@article{f7c36b1d10b742d29f7637e6ac3efe0e,
title = "Do Medical Complications Impact Long-Term Outcomes in Prolonged Disorders of Consciousness?",
abstract = "OBJECTIVE: To investigate medical complications (MCs) occurring within 6 months postinjury 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.PARTICIPANTS: Patients (N=194) with DoC (142 in vegetative state [VS], 52 in minimally conscious state; traumatic etiology 43, anoxic 69, vascular 82) consecutively admitted to a neurorehabilitation unit within 1-3 months postonset.INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Mortality and improvements in clinical diagnosis and functional disability level (assessed by Coma Recovery Scale-Revised [CRS-R] and Disability Rating Scale) at 12, 24, and 36 months postonset.RESULTS: Within 6 months postinjury, 188 of 194 patients (>95{\%}) developed at least 1 MC and 142 of them (73{\%}) showed at least 1 severe MC. Respiratory and musculoskeletal-cutaneous MCs were the most frequent, followed by endocrino-metabolic abnormalities. Follow-up, complete in 189 of 194 patients, showed that male sex and endocrine-metabolic MCs were associated with higher risk of mortality at all timepoints. Old age, anoxic etiology, lower CRS-R total scores, and diagnosis of VS at study entry predicted no clinical and functional improvements at most timepoints; however, epilepsy predicted no improvement in diagnosis at 24 months postonset only.CONCLUSIONS: MCs are very frequent in patients with DoC within at least 6 months after brain injury, regardless of clinical diagnosis, etiology, and age. Endocrino-metabolic MCs are independent predictors of mortality at all timepoints; however,epilepsy predicted poor long-term outcome. Occurrence and severity of MCs in patients with DoC call for long-term appropriate levels of care after the postacute phase.",
author = "Anna Estraneo and Vincenzo Loreto and Orsola Masotta and Angelo Pascarella and Luigi Trojano",
note = "Copyright {\circledC} 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = "12",
doi = "10.1016/j.apmr.2018.04.024",
language = "English",
volume = "99",
pages = "2523--2531.e3",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",
number = "12",

}

TY - JOUR

T1 - Do Medical Complications Impact Long-Term Outcomes in Prolonged Disorders of Consciousness?

AU - Estraneo, Anna

AU - Loreto, Vincenzo

AU - Masotta, Orsola

AU - Pascarella, Angelo

AU - Trojano, Luigi

N1 - Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

PY - 2018/12

Y1 - 2018/12

N2 - OBJECTIVE: To investigate medical complications (MCs) occurring within 6 months postinjury 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.PARTICIPANTS: Patients (N=194) with DoC (142 in vegetative state [VS], 52 in minimally conscious state; traumatic etiology 43, anoxic 69, vascular 82) consecutively admitted to a neurorehabilitation unit within 1-3 months postonset.INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Mortality and improvements in clinical diagnosis and functional disability level (assessed by Coma Recovery Scale-Revised [CRS-R] and Disability Rating Scale) at 12, 24, and 36 months postonset.RESULTS: Within 6 months postinjury, 188 of 194 patients (>95%) developed at least 1 MC and 142 of them (73%) showed at least 1 severe MC. Respiratory and musculoskeletal-cutaneous MCs were the most frequent, followed by endocrino-metabolic abnormalities. Follow-up, complete in 189 of 194 patients, showed that male sex and endocrine-metabolic MCs were associated with higher risk of mortality at all timepoints. Old age, anoxic etiology, lower CRS-R total scores, and diagnosis of VS at study entry predicted no clinical and functional improvements at most timepoints; however, epilepsy predicted no improvement in diagnosis at 24 months postonset only.CONCLUSIONS: MCs are very frequent in patients with DoC within at least 6 months after brain injury, regardless of clinical diagnosis, etiology, and age. Endocrino-metabolic MCs are independent predictors of mortality at all timepoints; however,epilepsy predicted poor long-term outcome. Occurrence and severity of MCs in patients with DoC call for long-term appropriate levels of care after the postacute phase.

AB - OBJECTIVE: To investigate medical complications (MCs) occurring within 6 months postinjury 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.PARTICIPANTS: Patients (N=194) with DoC (142 in vegetative state [VS], 52 in minimally conscious state; traumatic etiology 43, anoxic 69, vascular 82) consecutively admitted to a neurorehabilitation unit within 1-3 months postonset.INTERVENTIONS: Not applicable.MAIN OUTCOME MEASURES: Mortality and improvements in clinical diagnosis and functional disability level (assessed by Coma Recovery Scale-Revised [CRS-R] and Disability Rating Scale) at 12, 24, and 36 months postonset.RESULTS: Within 6 months postinjury, 188 of 194 patients (>95%) developed at least 1 MC and 142 of them (73%) showed at least 1 severe MC. Respiratory and musculoskeletal-cutaneous MCs were the most frequent, followed by endocrino-metabolic abnormalities. Follow-up, complete in 189 of 194 patients, showed that male sex and endocrine-metabolic MCs were associated with higher risk of mortality at all timepoints. Old age, anoxic etiology, lower CRS-R total scores, and diagnosis of VS at study entry predicted no clinical and functional improvements at most timepoints; however, epilepsy predicted no improvement in diagnosis at 24 months postonset only.CONCLUSIONS: MCs are very frequent in patients with DoC within at least 6 months after brain injury, regardless of clinical diagnosis, etiology, and age. Endocrino-metabolic MCs are independent predictors of mortality at all timepoints; however,epilepsy predicted poor long-term outcome. Occurrence and severity of MCs in patients with DoC call for long-term appropriate levels of care after the postacute phase.

U2 - 10.1016/j.apmr.2018.04.024

DO - 10.1016/j.apmr.2018.04.024

M3 - Article

VL - 99

SP - 2523-2531.e3

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

SN - 0003-9993

IS - 12

ER -