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Related Experiment Video

Updated: Jul 19, 2026

Assessment and Communication for People with Disorders of Consciousness
07:37

Assessment and Communication for People with Disorders of Consciousness

Published on: August 1, 2017

Prognosis of the posttraumatic vegetative state.

R Braakman1, W B Jennett, J M Minderhoud

  • 1Department of Neurosurgery, Erasmus University, Rotterdam, The Netherlands.

Acta Neurochirurgica
|January 1, 1988
PubMed
Summary

Severe brain injury coma patients rarely achieve independence. Age over 40 and prolonged vegetative state after 3 months predict poor outcomes, with only 1% independent after one year.

Area of Science:

  • Neurology
  • Neuroscience
  • Critical Care Medicine

Background:

  • Severe brain injury frequently results in prolonged coma.
  • Predicting outcomes for comatose patients is crucial for clinical management and patient care.

Purpose of the Study:

  • To investigate the long-term outcomes of patients with severe brain injury who remain comatose for over 6 hours.
  • To identify prognostic indicators for recovery of consciousness and independence.

Main Methods:

  • Retrospective analysis of 1373 patients with severe brain injury and coma lasting over 6 hours.
  • Assessment of patient status (vegetative state, consciousness, independence) at 1 month, 3 months, and 1 year post-injury.
  • Evaluation of clinical features (age, pupillary reactions, eye movements) as predictors of outcome.

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Main Results:

  • 10% of patients were in a vegetative state at 1 month; only 1% remained so at 1 year.
  • No patients over 40 regained independence within the first year.
  • Patients in a vegetative state at 3 months showed no recovery of independence, regardless of age.
  • Predicting an unfavorable outcome (death or irreversible coma) within one year was possible with high probability (p>0.95) in only 10% of patients within the first two weeks.
  • Distinguishing between persistent vegetative state and death with fair probability (p>0.80) was not possible at any time point post-coma onset.

Conclusions:

  • Recovery of independence after severe brain injury coma is uncommon, particularly for older patients or those with prolonged vegetative states.
  • Early clinical indicators can predict unfavorable outcomes in a subset of patients, but precise prediction of persistent vegetative state versus death remains challenging.
  • Prognostication requires careful consideration of multiple factors including age, duration of coma, and specific neurological signs.