Development of a simple score to predict outcome for unresponsive wakefulness syndrome

Abstract

IntroductionAccurate assessment of prognosis for patients with unresponsive wakefulness syndrome (UWS; formerly vegetative state) may help clinicians and families guide the type and intensity of therapy; however, there is no suitable and accurate means to predict the outcome so far. We aimed to develop a simple bedside scoring system to predict the likelihood of awareness recovery in patients with UWS.MethodsWe prospectively enrolled 56 patients (age range 10 to 73 years) with UWS 3 to 12 weeks post-onset. We collected demographic data and performed neurological, serological and neurophysiological tests at study entry. Each patient received a one year follow-up, during which awareness recovery was assessed by experienced physicians on the basis of clinical criteria. Univariate and multivariable analyses were employed to assess the relationships between predictors and awareness recovery.ResultsA total of 56 participants were included in the study; of these, 24 patients recovered awareness, 3 with moderate disabilities, 8 with severe disabilities, 12 were in a minimally conscious state, and 1 died after recovery. During the study, 23 patients remained in UWS and 9 died in UWS. Motor response, type of brain injury, electroencephalogram reactivity, sleep spindles and N20 were shown to be independent predictors for awareness recovery. Based on their coefficients in the model, we assigned these predictors with 1 point each and created a 5-point score for prediction of awareness recovery. The resulting score showed good predictive accuracy in the derivation cohort. The area under the receiver operating characteristic curve for the score was 0.918 with 87.50% sensitivity.ConclusionThis simple bedside prognostic score can be used to predict the probability of awareness recovery in UWS, thus provide families and clinicians with useful outcome information.

Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review

“…Compared with patients with good prognosis, patients with poor prognosis had less frequent reactive EEG patterns as well as sleep architecture ( p < 0.004). Pediatric CPC Kang et al (2014) [ 61 ] Mixed 56 Performance of the variable reactive EEG for recovery of awareness: OR = 21.648 (2.212 to 211.870). 66.7 (44.7–83.6) 75.0 (56.2–87.9) 66.7 (44.7–83.6) 75.0 (56.2–87.9) GOS at 1 year follow-up Visual only Bagnato et al (2017) [ 33 ] Mixed 28 5 of the 16 patients with consciousness improvement showed EEG-R on baseline EEG (at admission), which was absent in all patients without improvement.…”

A Systematic Review and Meta-Analysis of the Relationship Between Brain Data and the Outcome in Disorders of Consciousness

“…Although EEG reactivity was measured to very different stimuli [e.g., to passive ( 23 ) or forced eyes opening ( 19 , 20 ), to pain ( 34 , 41 ), to warm water ( 39 ), and no description was given by Sarà et al ( 48 )] and the definition of reactivity substantially varied, the results are very homogenous across the reports. Moreover, this was the only group of predictor variables whose predictive value was significant for both improvement criteria (transition from UWS to MCS and the recovery of consciousness).…”

Night sleep in patients with vegetative state

“…The subjectivity can, of course, be avoided if we decide for purely automatic methods (Kang et al ., ; Malinowska et al ., ). This strategy, however, is related to the risk to obtain quantitative data whose functional meaning may be difficult to interpret.…”