Children and young adults in a prolonged unconscious state after severe brain injury: Long-term functional outcome as measured by the DRS and the GOSE after early intensive neurorehabilitation

Eilander, H.J.; Timmerman, R. B. W.; Scheirs, J.G.M.; Heugten, Caroline van; Kort, Paul L.M. de; Prevo, A. J. H.

doi:10.1080/02699050601151795

Cited by 27 publications

(33 citation statements)

References 29 publications

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“…In light of these differences, outcomes and conclusions are understandably disparate across studies. For example, mortality rates for individuals with DOC range from 5 to 65%, with earlier studies and those from acute neurosurgical units yielding the highest rates of patient death (Braakman et al, 1998;Bricolo et al, 1980;Eilander et al, 2005Eilander et al, , 2007Estraneo et al, 2010;Fields et al, 1993;Giacino and Kalmar, 1997;Giacino et al, 1991;Heindl and Laub, 1996;Higashi et al, 1977;Lammi et al, 2005). Rates of recovery of consciousness range from 14 to 95% (Dubroja et al, 1995;Estraneo et al, 2010;Katz et al, 2009;Lammi et al, 2005;Luauté et al, 2010).…”

Section: Introductionmentioning

confidence: 95%

“…Existing studies vary in definition of DOC; setting (e.g., neurointensive care units vs. rehabilitation units); global region of health care provision (e.g., Europe vs. North America); study sample (e.g., children vs. adults, trauma vs. non-trauma, time since injury); length of follow-up; and outcomes evaluated (Braakman et al, 1998;Bricolo et al, 1980;Dubroja et al, 1995;Eilander et al, 2005Eilander et al, , 2007Estraneo et al, 2010;Fields et al, 1993;Giacino and Kalmar, 1997;Giacino et al,1991;Heindl and Laub, 1996;Higashi et al, 1977;Katz et al, 2009;Levin et al, 1991;Luauté et al, 2010;Ng and Chua, 2005). In light of these differences, outcomes and conclusions are understandably disparate across studies.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal Outcome of Patients with Disordered Consciousness in the NIDRR TBI Model Systems Programs

Nakase‐Richardson

Whyte

Giacino

et al. 2012

Journal of Neurotrauma

188

140

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Few studies address the course of recovery from prolonged disorders of consciousness (DOC) after severe traumatic brain injury (TBI). This study examined acute and long-term outcomes of persons with DOC admitted to acute inpatient rehabilitation within the National Institute on Disability and Rehabilitation Research (NIDRR) TBI Model Systems Programs (TBIMS). Of 9028 persons enrolled from 1988 to 2009, 396 from 20 centers met study criteria. Participants were primarily male (73%), Caucasian (67%), injured in motor vehicle collision (66%), with a median age of 28, and emergency department Glasgow Coma Scale (GCS) score of 3. Participant status was evaluated at acute rehabilitation admission and discharge and at 1, 2, and 5 years post-injury. During inpatient rehabilitation, 268 of 396 (68%) regained consciousness and 91 (23%) emerged from post-traumatic amnesia (PTA). Participants demonstrated significant improvements on GCS (z=16.135, p≤0.001) and Functional Independence Measure (FIM) (z=15.584, p≤0.001) from rehabilitation admission (median GCS=9; FIM=18) to discharge (median GCS=14; FIM=43). Of 337 with at least one follow-up visit, 28 (8%) had died by 2.1 years (mean) after discharge. Among survivors, 66 (21%) improved to become capable of living without in-house supervision, and 63 demonstrated employment potential using the Disability Rating Scale (DRS). Participants with follow-up data at 1, 2, and 5 years post-injury (n=108) demonstrated significant improvement across all follow-up evaluations on the FIM Cognitive and Supervision Rating Scale (p<0.01). Significant improvements were observed on the DRS and FIM Motor at 1 and 2 years post-injury (p<0.01). Persons with DOC at the time of admission to inpatient rehabilitation showed functional improvement throughout early recovery and in years post-injury.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Longitudinal Outcome of Patients with Disordered Consciousness in the NIDRR TBI Model Systems Programs

Nakase‐Richardson

Whyte

Giacino

et al. 2012

Journal of Neurotrauma

188

140

View full text Add to dashboard Cite

show abstract

“…[5][6][7][30][31][32] As a whole, these studies have shown that patients who survive a TBI achieve greater functional and cognitive recovery than those with non-TBI 2, 3,9,[27][28][29]33 and that patients with anoxic brain injury have a similar rate of recovery compared with patients with TBI but have a worse outcome, as they tend to reach the upper limit of their potential more quickly than the former. 5,6,8,[30][31][32] However, many studies have not focused on severe ABI but instead included patients with a range of injury severity from mild to severe.…”

mentioning

confidence: 98%

“…Moreover, studies involving adult patients with severe ABI cannot be compared with studies that include children and young adults. 27,29 About the prognostic factors, the most commonly studied are age, 10,12,17,18,20,35,36 coma duration, 10,21 posttraumatic amnesia, 10,16 early rehabilitation, 22,[36][37][38] and functional and cognitive levels at admission. 12,[16][17][18]22,[39][40][41] Unfortunately, the results are sometimes contradictory 42,43 and thus only partially clear and congruent conclusions can be drawn and applied to clinical practice in the management of patients with severe ABI of different etiologies.…”

mentioning

confidence: 99%

“…About functional outcomes, some studies focus on only 1 etiology such as stroke, [17][18][19] TBI, [20][21][22][23][24][25][26] or anoxic brain injury 9 whereas others have compared traumatic and nontraumatic brain injuries 2,3,12,[27][28][29] or 2 etiologies such as traumatic and anoxic brain injury. [5][6][7][30][31][32] As a whole, these studies have shown that patients who survive a TBI achieve greater functional and cognitive recovery than those with non-TBI 2, 3,9,[27][28][29]33 and that patients with anoxic brain injury have a similar rate of recovery compared with patients with TBI but have a worse outcome, as they tend to reach the upper limit of their potential more quickly than the former.…”

mentioning

confidence: 99%

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Factors Predicting Functional and Cognitive Recovery Following Severe Traumatic, Anoxic, and Cerebrovascular Brain Damage

Smania¹,

Avesani²,

Roncari³

et al. 2013

Journal of Head Trauma Rehabilitation

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Will time heal? A long‐term follow‐up of severe disorders of consciousness

Steppacher

Kaps

Kißler

2014

Ann Clin Transl Neurol

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ObjectiveLittle is known about the long-term outcome of patients with disorders of consciousness (DOCs) such as unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS). We describe the disease course of a large group of DOC patients 2–14 years after brain damage.MethodsIn 102 patients (59 UWS, 43 MCS), clinical and demographic variables from disorder onset were related to the patients' outcomes 2–14 years after discharge. Etiology, age at event, time since onset, gender, and home care versus institutional care were assessed as predictors and similarities and differences between UWS and MCS determined.ResultsSeventy-one percent of the patients had passed away or showed no improvement in condition. Twenty-nine percent regained consciousness and developed some communicative capacities. The time a syndrome persisted did not predict clinical outcome in either condition. Six patients regained consciousness after more than 3 years. Of these, five had been UWS (42% of recovered UWS, three traumatic origins, one tumor, one hypoxia) and one MCS (5% of recovered MCS, traumatic origin). In UWS, younger patients, those cared for at home, and in tendency those with traumatic origins, were more likely to recover. In MCS, no reliable outcome predictors were found.InterpretationCurrent predictors are too vague for single patient predictions. This study identifies a subgroup of late-recovering patients, casting doubt on the 12-month boundary, after which UWS is stated to be permanent. Routine reexamination, use of more reliable outcome predictors and research determining optimal care settings are needed to inform the crucial decisions made for these patients.

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Children and young adults in a prolonged unconscious state after severe brain injury: Long-term functional outcome as measured by the DRS and the GOSE after early intensive neurorehabilitation

Cited by 27 publications

References 29 publications

Longitudinal Outcome of Patients with Disordered Consciousness in the NIDRR TBI Model Systems Programs

Longitudinal Outcome of Patients with Disordered Consciousness in the NIDRR TBI Model Systems Programs

Factors Predicting Functional and Cognitive Recovery Following Severe Traumatic, Anoxic, and Cerebrovascular Brain Damage

Will time heal? A long‐term follow‐up of severe disorders of consciousness

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