Citation

Giacino JT, Sherer M, Christoforou A, Maurer-Karattup P, Hammond F, Long D, Bagiella E. J. Neurotrauma 2019; ePub(ePub): ePub.

Affiliation

Icahn School of Medicine at Mount Sinai, Biostatistics, New York, New York, United States; emilia.bagiella@mountsinai.org.

Copyright

(Copyright © 2019, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2019.6429

PMID

31502498

Abstract

The extent of behavioral recovery that occurs in patients with traumatic disorders of consciousness (DoC) following discharge from the acute care setting has been under-studied and increases the risk of overly-pessimistic outcome prediction. The aim of this observational cohort study was to systematically track the behavioral and functional recovery in patients with prolonged traumatic DoC following discharge from the acute care setting. Standardized behavioral data were acquired from 95 patients in a minimally conscious (MCS) or vegetative state (VS) recruited from 11 clinic sites and randomly assigned to the placebo arm of a previously-completed prospective clinical trial. Patients were followed for six weeks by blinded observers to determine frequency of recovery of six target behaviors associated with functional status. The Coma Recovery Scale-Revised and Disability Rating Scale were used to track reemergence of target behaviors and assess degree of functional disability, respectively. Twenty percent (95% CI: 13-30%) of participants (mean age 37.2; median 47 days post-injury; 69 men) recovered all six target behaviors within the 6-week observation period. The odds of recovering a specific target behavior were 3.2 (95% CI: 1.2-8.1) to 7.8 (95% CI: 2.7-23.0) times higher for patients in MCS compared to VS. Patients with preserved language function ("MCS+") recovered the most behaviors (P≤.002) and had the least disability (P≤.002) at follow-up. These findings suggest that recovery of high-level behaviors underpinning functional independence is common in patients with prolonged traumatic DoC. Clinicians involved in early prognostic counseling should recognize that failure to emerge from traumatic DoC before 28 days does not necessarily portend unfavorable outcome.

Language: en

Keywords

ADULT BRAIN INJURY; OUTCOME MEASURES; RECOVERY; REHABILITATION; TRAUMATIC BRAIN INJURY