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

A. Estraneo, O. Masotta, M. Bartolo, F. Pistoia, C. Perin, S. Marino, L. Lucca, V. Pingue, E. Casanova, A. Romoli, S. Gentile, R. Formisano, G. P. Salvi, F. Scarponi, A. De Tanti, P. Bongioanni, E. Rossato, A. Santangelo, A. R. Diana, M. GambarinD. Intiso, R. Antenucci, S. Premoselli, M. Bertoni, F. De Bellis

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
JournalBrain Injury
Publication statusE-pub ahead of print - Dec 2020


  • clinical complexity
  • Disorders of consciousness
  • medical complications
  • neurorehabilitation
  • outcome

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Developmental and Educational Psychology
  • Clinical Neurology


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