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

Anna Estraneo1, Vincenzo Loreto1, Orsola Masotta1

  • 1Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, IRCCS Maugeri ICS, Telese Terme (BN), Italy.

Archives of Physical Medicine and Rehabilitation
|May 29, 2018
PubMed
Abstract

Insights

Medical complications are frequent in brain-injured patients with disorders of consciousness (DoC). Endocrino-metabolic complications predict mortality, while epilepsy indicates poor long-term outcomes, necessitating ongoing care.

Area of Science:

  • Neurology
  • Rehabilitation Medicine
  • Critical Care Medicine

Background:

  • Patients with prolonged disorders of consciousness (DoC) following brain injury are susceptible to medical complications (MCs).
  • Understanding the incidence and impact of these MCs is crucial for patient management and prognostication.

Purpose of the Study:

  • To investigate the medical complications (MCs) occurring within 6 months post-brain injury in patients with DoC.
  • To evaluate the impact of these MCs on mortality and long-term clinical outcomes.

Main Methods:

  • A prospective observational cohort study was conducted on 194 patients with DoC admitted to a neurorehabilitation unit.
  • Data on medical complications, mortality, and functional status (using CRS-R and DRS) were collected at 12, 24, and 36 months post-onset.

Main Results:

  • Over 95% of patients developed at least one MC within 6 months, with respiratory and musculoskeletal-cutaneous complications being most frequent.
  • Male sex and endocrino-metabolic MCs were associated with increased mortality.
  • Older age, anoxic etiology, lower CRS-R scores, and vegetative state diagnosis predicted poorer long-term functional outcomes.

Conclusions:

  • Medical complications are highly prevalent in DoC patients within 6 months post-injury.
  • Endocrino-metabolic MCs independently predict mortality, whereas epilepsy is linked to poor long-term outcomes.
  • The frequent occurrence and severity of MCs underscore the need for sustained, appropriate care beyond the acute phase for DoC patients.
Keywords:
ComplicationsMinimally conscious stateOutcomeRehabilitationVegetative state

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