Demographical and clinical indices for long-term evolution of patients in vegetative or in minimally conscious state

Estraneo, Anna; Bellis, Francesco De; Masotta, Orsola; Loreto, V.; Fiorenza, Salvatore; Sapio, Monica; Trojano, Luigi

doi:10.1080/02699052.2019.1658220

Cited by 28 publications

(53 citation statements)

References 48 publications

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“…38,[41][42][43][44] Besides these demographic and anamnestic indicators of better outcome, we found a significant role of the CRS-R total score in predicting better clinical evolution. The present findings supported the prognostic validity of CRS-R total score, in keeping with previous short-term 11 and long-term 10,45 longitudinal studies on individuals with DoC. Moreover, it is important to emphasize that age, time from injury, and CRS-R total score remained significant outcome predictors after accounting for covariates such as clinical diagnosis, etiology of brain injury, and functional disability level, which were considered significant outcome predictors in previous studies.…”

Section: Discussionsupporting

confidence: 91%

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

et al. 2020

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Objective.This international multi-center, 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 neurophysiological data were collected at study entry. Patients were then followed-up for assessing the primary outcome, i.e. clinical diagnosis according to standardized criteria at 6 months post-injury.Results.We enrolled 147 patients (44 women; mean age: 49.4 [95% confidence intervals: 46.1-52.6] years; VS/UWS= 71, MCS= 76; traumatic= 55, vascular= 56, anoxic= 36; mean time post-injury= 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 post-injury, 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 multi-center, international study aims to stimulate further research that drives international consensus regarding standardization of prognostic procedures for patients with DoC.

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Section: Discussionsupporting

confidence: 91%

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

et al. 2020

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“…The main predictors for mortality are older age, nontraumatic aetiology, short time postinjury, and diagnosis of VS/UWS compared to MCS [4,7,9]. Moreover, recent studies highlighted that additional clinical variables, such as the Coma Recovery Scale-Revised (CRS-R) [10] total score [7], and electrophysiological markers, such as the absence of somatosensory evoked potentials (SEPs) [11] or eventrelated potentials (ERPs) [12], and worse electroencephalographic (EEG) background activity [13,14], could predict poor outcome, including mortality, in patients with pDoC. However, most of these prognostic studies evaluated a limited number of predictors, thus precluding detection of the independent predictive value of each variable [15].…”

Section: Introductionmentioning

confidence: 99%

Risk factors for 2‐year mortality in patients with prolonged disorders of consciousness: An international multicentre study

Estraneo

Magliacano

Fiorenza

et al. 2021

Euro J of Neurology

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Background and purpose Patients with prolonged disorders of consciousness (pDoC) have a high mortality rate due to medical complications. Because an accurate prognosis is essential for decision‐making on patients' management, we analysed data from an international multicentre prospective cohort study to evaluate 2‐year mortality rate and bedside predictors of mortality. Methods We enrolled adult patients in prolonged vegetative state/unresponsive wakefulness syndrome (VS/UWS) or minimally conscious state (MCS) after traumatic and nontraumatic brain injury within 3 months postinjury. At enrolment, we collected demographic (age, sex), anamnestic (aetiology, time postinjury), clinical (Coma Recovery Scale–Revised [CRS‐R], Disability Rating Scale, Nociception Coma Scale–Revised), and neurophysiologic (electroencephalogram [EEG], somatosensory evoked and event‐related potentials) data. Patients were followed up to gather data on mortality up to 24 months postinjury. Results Among 143 traumatic (n = 55) and nontraumatic (n = 88) patients (VS/UWS, n = 68, 19 females; MCS, n = 75, 22 females), 41 (28.7%) died within 24 months postinjury. Mortality rate was higher in VS/UWS (42.6%) than in MCS (16%; p < 0.001). Multivariate regression in VS/UWS showed that significant predictors of mortality were older age and lower CRS‐R total score, whereas in MCS female sex and absence of alpha rhythm on EEG at study entry were significant predictors. Conclusions This study demonstrated that a feasible multimodal assessment in the postacute phase can help clinicians to identify patients with pDoC at higher risk of mortality within 24 months after brain injury. This evidence can help clinicians and patients' families to navigate the complex clinical decision‐making process and promote an international standardization of prognostic procedures for patients with pDoC.

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“…Minimally conscious state (MCS) is a "gray zone" transition state associated with PVS/UWS. 14 MCS is occasionally a long-term destination, but more often, it is a transition state from coma to a more complete restoration of consciousness. At its simplest level, it is used to describe a patient who can understand, act on, and follow commands, or track a moving object, but do practically nothing else.…”

Section: Disorders Of Consciousnessmentioning

confidence: 99%

“…MCS-minus indicates low-level intentional actions, such as visual pursuits and localization of noxious stimuli, whereas MCS-plus indicates complex intentional behaviors, such as command following or verbalization. 14…”

Section: Disorders Of Consciousnessmentioning

confidence: 99%

Outcome and prognostication after cardiac arrest

Henson

Rawanduzy

Salazar

et al. 2021

Annals of the New York Academy of Sciences

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The outcome after out-of-hospital cardiac arrest has historically been grim at best. The current overall survival rate of patients admitted to a hospital is approximately 10%, making cardiac arrest one of the leading causes of death in the United States. The situation is improving with the incorporation of therapeutic temperature modulation, aggressive prevention of secondary brain injury, and improved access to advanced cardiovascular support, all of which have decreased mortality and allowed for better outcomes. Mortality after cardiac arrest is often the direct result of active withdrawal of life-sustaining therapy based on the perception that neurological recovery is not possible. This reality highlights the importance of providing accurate estimates of neurological prognosis to decision makers when discussing goals of care. The current standard of care for assessing neurological status in patients with hypoxic-ischemic encephalopathy emphasizes a multimodal approach that includes five elements: (1) neurological examination off sedation, (2) continuous electroencephalography, (3) serum neuron-specific enolase levels, (4) magnetic resonance brain imaging, and (5) somatosensory-evoked potential testing. Sophisticated decision support systems that can integrate these clinical, imaging, and biomarker and neurophysiologic data and translate it into meaningful projections of neurological outcome are urgently needed.

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Demographical and clinical indices for long-term evolution of patients in vegetative or in minimally conscious state

Cited by 28 publications

References 48 publications

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

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

Risk factors for 2‐year mortality in patients with prolonged disorders of consciousness: An international multicentre study

Outcome and prognostication after cardiac arrest

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