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

      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)
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