Do Medical Complications Impact Long-Term Outcomes in Prolonged Disorders of Consciousness?

Estraneo, Anna; Loreto, V.; Masotta, Orsola; Pascarella, Angelo; Trojano, Luigi

doi:10.1016/j.apmr.2018.04.024

Cited by 53 publications

(61 citation statements)

References 38 publications

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“…The main limitation of this study is that the outcomes at 2 months cannot be considered as definitive. Although the detected predictors are similar to those reported in long-term longitudinal studies [9][10][11][12][13][14][15][16][17][18][19][20][21], we are aware that this study needs further evaluation before translating to clinical practice. Again, the lack of a deeper evaluation of medical complications might have influenced our data.…”

Section: Discussionsupporting

confidence: 75%

Outcome prediction in disorders of consciousness: the role of coma recovery scale revised

Lucca¹,

Lofaro

Pignolo

et al. 2019

Preprint

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Background: To evaluate the utility of the revised coma remission scale (CRS-r), together with other clinical variables, in predicting emergence from disorders of consciousness (DoC) during intensive rehabilitation care. Methods: Data were retrospectively extracted from the medical records of patients enrolled in a specialized intensive rehabilitation unit. 123 patients in a vegetative state (VS) and 57 in a minimally conscious state (MCS) were included and followed for a period of 8 weeks. Demographical and clinical factors were used as outcome measures. Univariate and multivariate Cox regression models were employed for examining potential predictors for clinical outcome along the time. Results: VS and MCS groups were matched for demographical and clinical variables (i.e., age, aetiology, tracheostomy and route of feeding). Within 2 months after admission in intensive neurorehabilitation unit, 3.9% were dead, 35.5% had a full recovery of consciousness and 66.7% remained in VS or MCS. Multivariate analysis demonstrated that the best predictor of functional improvement was the CRS-r scores. In particular, patients with values greater than 12 at admission were those with a favourable likelihood of emergence from DoC. Conclusions: Our study highlights the role of the CRS-r scores for predicting a short-term favorable outcome.

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Section: Discussionsupporting

confidence: 75%

Outcome prediction in disorders of consciousness: the role of coma recovery scale revised

Lucca¹,

Lofaro

Pignolo

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…Misdiagnosis is one of the major concerns in Disorders of Consciousness (DoC). 1 Confounding factors in the behavioral evaluation of overt responsiveness include comorbidities, 2 extreme motor deficits and severe spasticity, 3 diffuse pain, 4 neuropsychological deficits, such as aphasia, 5 psychomotor agitation, 6 oppositive attitudes, and inertia, such as in akinetic mutism, 7 as well as iatrogenic effects (anti-epileptics, sedative drugs, anti-spastic agents, etc. ).…”

mentioning

confidence: 99%

Coma Recovery Scale-Revised With and Without the Emotional Stimulation of Caregivers

Formisano

Contrada

Iosa

et al. 2019

Can. J. Neurol. Sci.

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ABSTRACT:The Coma Recovery Scale-Revised (CRS-R) is the gold standard of responsiveness assessment in patients with disorder of consciousness. The purpose of this study is to search for the efficacy of the caregivers’ involvement in the evaluation of responsiveness in these patients. Responsiveness assessment was performed in 15 patients with CRS-R. The CRS-R was administered with and without the emotional stimulation of the primary caregiver at different times. Our preliminary findings seem to suggest that, including also the caregivers during CRS-R assessment, may obtain better responsiveness scoring than that obtained by professionals and might reduce the misdiagnosis rate.

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“…The current literature on the outcome predictors of the emergence from DoC is in its moderate infancy and nowadays reliable markers have not been fully identified [9][10][11][12][13][14][15][16][17][18][19][20][21]. After brain injury events, the early stages are crucial to determine the severity of the disease and to help clinicians and patients' family in decision-making processes.…”

Section: Discussionmentioning

confidence: 99%

Outcome prediction in disorders of consciousness: the role of coma recovery scale revised

Lucca¹,

Lofaro

Pignolo

et al. 2019

Preprint

View full text Add to dashboard Cite

Background: To evaluate the utility of the revised coma remission scale (CRS-r), together with other clinical variables, in predicting emergence from disorders of consciousness (DoC) during intensive rehabilitation care. Method: Data were retrospectively extracted from the medical records of patients enrolled in a specialized intensive rehabilitation unit. 123 patients in a vegetative state (VS) and 57 in a minimally conscious state (MCS) were included and followed for a period of 8 weeks. Demographical and clinical factors were used as outcome measures. Univariate and multivariate Cox regression models were employed for examining potential predictors for clinical outcome along the time. Results: VS and MCS groups were matched for demographical and clinical variables (i.e., age, aetiology, tracheostomy and route of feeding). Within 2 months after admission in intensive neurorehabilitation unit, 3.9% were dead, 35.5% had a full recovery of consciousness and 66.7% remained in VS or MCS. Multivariate analysis demonstrated that the best predictor of functional improvement was the CRS-r scores. In particular, patients with values greater than 12 at admission were those with a favourable likelihood of emergence from DoC. Conclusions: Our study highlights the role of the CRS-r scores for predicting a short-term favorable outcome.

show abstract

Do Medical Complications Impact Long-Term Outcomes in Prolonged Disorders of Consciousness?

Cited by 53 publications

References 38 publications

Outcome prediction in disorders of consciousness: the role of coma recovery scale revised

Outcome prediction in disorders of consciousness: the role of coma recovery scale revised

Coma Recovery Scale-Revised With and Without the Emotional Stimulation of Caregivers

Outcome prediction in disorders of consciousness: the role of coma recovery scale revised

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