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Multicenter prospective study on predictors of short-term outcome in disorders of consciousness

Estraneo A 1 , Fiorenza S 2 , Magliacano A 2 , Formisano R 2 , Mattia D 2 , Grippo A 2 Show all authors , Romoli AM 2 , Angelakis E 2 , Cassol H 2 , Thibaut A 2 , Gosseries O 2 , Lamberti G 2 , Noé E 2 , Bagnato S 2 , Edlow BL 2 , Chatelle C 2 , Lejeune N 2 , Veeramuthu V 2 , Bartolo M 2 , Toppi J 2 , Zasler N 2 , Schnakers C 2 , Trojano L 2 , IBIA DoC-SIG

Affiliations 

  • 1 From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA. aestraneo@gmail.com
  • 2 From IRCCS Fondazione Don Carlo Gnocchi (A.E., A.G., A.M.R.), Florence; Istituti Clinici Scientifici Maugeri IRCCS (S.F.), SB S.p.A., Laboratorio di Valutazione Multimodale dei Disordini della Coscienza, Telese Terme (BN); Department of Psychology (A.M., L.T.), University of Campania L. Vanvitelli, Caserta; Fondazione Santa Lucia IRCCS (R.F., D.M.), Rome, Italy; Neurosurgery Department (E.A.), University of Athens Medical School, Greece; Coma Science Group (H.C., A.T., O.G.), GIGA Consciousness, University and University Hospital of Liège, Belgium; Neurorehabilitation and Vegetative State Unit (G.L.), E. Viglietta, Cuneo, Italy; NEURORHB-Servicio de Neurorrehabilitación de Hospitales Vithas (E.N.), Valencia, Spain; Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries (S.B.), Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù, Italy; Center for Neurotechnology and Neurorecovery (B.L.E., C.C.), Department of Neurology, Massachusetts General Hospital, Boston; CHN William Lennox (N.L.), Ottignies, Belgium; Department of Psychology (V.V.), University of Reading Malaysia; Neurorehabilitation Unit (M.B.), HABILITA Zingonia/Ciserano, Bergamo; Department of Computer, Control and Management Engineering (J.T.), Sapienza University of Rome, Italy; Concussion Care Centre of Virginia, Ltd. (N.Z.), Richmond; and Research Institute (C.S.), Casa Colina Hospital and Centers for Healthcare, Pomona, CA
Neurology, 2020 09 15;95(11):e1488-e1499.
PMID: 32661102 DOI: 10.1212/WNL.0000000000010254

Abstract

OBJECTIVE: This international multicenter, prospective, observational study aimed at identifying predictors of short-term clinical outcome in patients with prolonged disorders of consciousness (DoC) due to acquired severe brain injury.

METHODS: Patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) or in minimally conscious state (MCS) were enrolled within 3 months from their brain injury in 12 specialized medical institutions. Demographic, anamnestic, clinical, and neurophysiologic data were collected at study entry. Patients were then followed up for assessing the primary outcome, that is, clinical diagnosis according to standardized criteria at 6 months postinjury.

RESULTS: We enrolled 147 patients (44 women; mean age 49.4 [95% confidence interval 46.1-52.6] years; VS/UWS 71, MCS 76; traumatic 55, vascular 56, anoxic 36; mean time postinjury 59.6 [55.4-63.6] days). The 6-month follow-up was complete for 143 patients (VS/UWS 70; MCS 73). With respect to study entry, the clinical diagnosis improved in 72 patients (VS/UWS 27; MCS 45). Younger age, shorter time postinjury, higher Coma Recovery Scale-Revised total score, and presence of EEG reactivity to eye opening at study entry predicted better outcome, whereas etiology, clinical diagnosis, Disability Rating Scale score, EEG background activity, acoustic reactivity, and P300 on event-related potentials were not associated with outcome.

CONCLUSIONS: Multimodal assessment could identify patients with higher likelihood of clinical improvement in order to help clinicians, families, and funding sources with various aspects of decision-making. This multicenter, international study aims to stimulate further research that drives international consensus regarding standardization of prognostic procedures for patients with DoC.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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