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Life expectancy of children in vegetative and minimally conscious states
D J Strauss1, S Ashwal, S M Day
1Department of Statistics, University of California, Riverside, Riverside, California, USA.
Insights
Survival in children with disorders of consciousness varied by mobility, not consciousness level. Mobile patients had better outcomes, indicating mobility is key for life expectancy in vegetative and minimally conscious states.
Area of Science:
- Pediatric neurology
- Neuroscience
- Rehabilitation medicine
Background:
- Children with disorders of consciousness (DoC) present unique challenges in prognosis.
- Estimating survival rates is crucial for clinical management and family counseling.
Purpose of the Study:
- To determine survival estimates for children in vegetative state (VS) and minimally conscious state (MCS).
- To compare survival rates based on mobility within MCS and across different etiologies.
Main Methods:
- Retrospective cohort study using data from California Department of Developmental Services (1988-1997).
- Analysis of 564 children in VS, 705 in immobile MCS, and 3,806 in mobile MCS.
- Categorization by etiology: acquired brain injury, perinatal/genetic, degenerative, and unknown.
Main Results:
- Eight-year survival rates were 63% (VS), 65% (immobile MCS), and 81% (mobile MCS).
- Acquired brain injury was associated with lower mortality; degenerative diseases with higher mortality.
- Mobility, not consciousness level, was a significant predictor of survival.
Conclusions:
- Mobility is a more critical factor than consciousness level in predicting survival for children with DoC.
- Etiology significantly impacts mortality rates, with degenerative conditions posing the highest risk.
- These findings have implications for prognostication and care planning for pediatric DoC.
Abstract:
We determined estimates of survival in children, 3-15 years of age, in the vegetative state (VS) (n = 564), immobile minimally conscious state (MCS) (n = 705), and mobile MCS (n = 3,806). Data were extracted from the annual Client Development Evaluation Reports of the California Department of Developmental Services between 1988 and 1997 using the operational definitions for these three states on the basis of 15 descriptive behavioral categories. Patients were also categorized according to the following four etiologies: acquired (traumatic and nontraumatic) brain injury; perinatal/genetic; degenerative; and unknown/undetermined. The percentage of patients surviving 8 years was 63%, 65%, and 81%, for the VS, immobile MCS, and mobile MCS, respectively. Children in the VS and MCSs with acquired brain injury had lower mortality rates and those with degenerative diseases the highest mortality rates. We observed little difference in survival between patients in the VS and immobile MCS, suggesting that the presence of consciousness is not a critical variable in determining life expectancy. Furthermore, survival was much greater for patients in the mobile MCS than for those in the immobile MCS, suggesting that mobility is more important in predicting survival than the level of consciousness.