Long‐term clinical evolution of patients with prolonged disorders of consciousness due to severe anoxic brain injury: A meta‐analytic study

Abstract

Background and purposeThe prognosis of prolonged (28 days to 3 months post‐onset) disorders of consciousness (pDoC) due to anoxic brain injury is uncertain. The present study aimed to evaluate the long‐term outcome of post‐anoxic pDoC and identify the possible predictive value of demographic and clinical information.MethodThis is a systematic review and meta‐analysis. The rates of mortality, any improvement in clinical diagnosis, and recovery of full consciousness at least 6 months after severe anoxic brain injury were evaluated. A cross‐sectional approach searched for differences in baseline demographic and clinical characteristics between survivors and non‐survivors, patients improved versus not improved, and patients who recovered full consciousness versus not recovered.ResultsTwenty‐seven studies were identified. The pooled rates of mortality, any clinical improvement and recovery of full consciousness were 26%, 26% and 17%, respectively. Younger age, baseline diagnosis of minimally conscious state versus vegetative state/unresponsive wakefulness syndrome, higher Coma Recovery Scale Revised total score, and earlier admission to intensive rehabilitation units were associated with a significantly higher likelihood of survival and clinical improvement. These same variables, except time of admission to rehabilitation, were also associated with recovery of full consciousness.ConclusionsPatients with anoxic pDoC might improve over time up to full recovery of consciousness and some clinical characteristics can help predict clinical improvement. These new insights could support clinicians and caregivers in the decision‐making on patient management.

Predicting outcome in disorders of consciousness: A mega‐analysis

“…Sex of the patients emerged as a significant predictive factor for the outcome, though with a rather moderate effect size. While previous studies on the effect of sex have yielded inconsistent results, 16,17,26 a recent large meta-analysis aligns with our findings, 32 suggesting that male patients, particularly husbands, may receive more effective care from their spouses than female patients. Although this factor can be real, it might result in a higher mortality rate among females rather than in an increased recovery rate in males.…”

“…Some recent large-scale clinical trials and a meta-analysis concluded that younger patients recover more frequently. 6,17,31,32 We were unable to confirm this Cumulative incidence (%) finding in the overall sample. However, our additional analysis revealed that older patients die earlier and more frequently than younger patients.…”

“…When the age of a patient was presented as an interval (e.g., [30][31][32][33][34][35][36][37][38][39][40], which took place in <2% of cases, we used the mean of the range. When only the beginning or the end of the interval was indicated (e.g., >60), we treated the values as missing.…”