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Outcomes of children in a persistent vegetative state
A I Fields1, D H Coble, M M Pollack
1Department of Critical Care Medicine, Children's National Medical Center, George Washington University School of Medicine, Washington, DC.
Critical Care Medicine
|December 1, 1993
Summary
Long-term home care for children in a vegetative state following neurologic injury yielded poor outcomes, with high mortality and significant costs. Most children showed minimal awareness, despite intensive nursing and personnel support.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Home Healthcare
Background:
- Neurologic injuries can result in a persistent vegetative state in children.
- Discharge to home care for these children presents unique challenges in terms of outcomes and resource utilization.
Purpose of the Study:
- To evaluate the long-term survival, functional status, and resource utilization of pediatric patients discharged home in a vegetative state.
- To assess caretaker satisfaction and perceived awareness in children receiving home-based care.
Main Methods:
- A case series design was employed, following twenty children diagnosed with a vegetative state.
- Home care interventions included professional nursing services.
- Outcomes were assessed via mailed questionnaires and telephone follow-up, focusing on survival, mental and functional status, costs, and personnel requirements.
Main Results:
- Over a 4.5-year follow-up, 40% of children died, while survivors remained totally dependent.
- Twelve of thirteen caretakers reported minimal awareness (e.g., voice recognition) in their children.
- Annual care costs averaged over $90,000 per patient, requiring 10-12 hours of daily nursing care.
Conclusions:
- The long-term prognosis for children discharged home in a vegetative state is poor, characterized by high mortality and limited functional improvement.
- Despite intensive home care, significant resource utilization and financial burden are associated with managing these complex pediatric cases.