Multicenter prospective study on predictors of short-term outcome in disorders of consciousness

IBIA DoC-SIG, Anna Estraneo, Salvatore Fiorenza, Alfonso Magliacano, Rita Formisano, Donatella Mattia, Antonello Grippo, Anna Maria Romoli, Efthymios Angelakis, Helena Cassol, Aurore Thibaut, Olivia Gosseries, Gianfranco Lamberti, Enrique Noé, Sergio Bagnato, Brian L. Edlow, Camille Chatelle, Nicolas Lejeune, Vigneswaran Veeramuthu, Michelangelo BartoloJlenia Toppi, Nathan Zasler, Caroline Schnakers, Luigi Trojano

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: This international multicenter, prospective, observational study aimed at identifying predictors of short-term clinical outcome in patients with prolonged disorders of consciousness (DoC) due to acquired severe brain injury. METHODS: Patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) or in minimally conscious state (MCS) were enrolled within 3 months from their brain injury in 12 specialized medical institutions. Demographic, anamnestic, clinical, and neurophysiologic data were collected at study entry. Patients were then followed up for assessing the primary outcome, that is, clinical diagnosis according to standardized criteria at 6 months postinjury. RESULTS: We enrolled 147 patients (44 women; mean age 49.4 [95% confidence interval 46.1-52.6] years; VS/UWS 71, MCS 76; traumatic 55, vascular 56, anoxic 36; mean time postinjury 59.6 [55.4-63.6] days). The 6-month follow-up was complete for 143 patients (VS/UWS 70; MCS 73). With respect to study entry, the clinical diagnosis improved in 72 patients (VS/UWS 27; MCS 45). Younger age, shorter time postinjury, higher Coma Recovery Scale-Revised total score, and presence of EEG reactivity to eye opening at study entry predicted better outcome, whereas etiology, clinical diagnosis, Disability Rating Scale score, EEG background activity, acoustic reactivity, and P300 on event-related potentials were not associated with outcome. CONCLUSIONS: Multimodal assessment could identify patients with higher likelihood of clinical improvement in order to help clinicians, families, and funding sources with various aspects of decision-making. This multicenter, international study aims to stimulate further research that drives international consensus regarding standardization of prognostic procedures for patients with DoC.

Original languageEnglish
Pages (from-to)e1488-e1499
JournalNeurology
Volume95
Issue number11
DOIs
Publication statusPublished - Sep 15 2020

ASJC Scopus subject areas

  • Clinical Neurology

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