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.
Keywords
List of abbreviations:
CIRS (Cumulative Illness Rating Scale), CRS-R (Coma Recovery Scale-Revised), DoC (disorders of consciousness), DRS (Disability Rating Scale), HO (heterotopic ossification), MC (medical complication), MCS (minimally conscious state), TBI (traumatic brain injury), VS (vegetative state)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 25, 2018
Footnotes
Supported by IRCCS Maugeri ICS.
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
