One-year outcome of brain injured patients undergoing early neurological rehabilitation: a prospective observational study

Abstract

Background The present study intended to analyze the outcome of patients with severe brain injury one-year after discharge from early rehabilitation. Methods Early neurological rehabilitation patients admitted to intensive or intermediate care units and discharged between June 2018 and May 2020 were screened for eligibility. The level of consciousness was evaluated using the Coma Recovery Scale-Revised (CRS-R) upon admission and at discharge. At one-year follow-up, the outcome was assessed with the Glasgow Outcome Scale-extended (GOSE). Demographical and clinical data collected during inpatient rehabilitation were used to predict the outcome 1 year after discharge. Results Two hundred sixty-four patients (174 males, 90 females) with a median age of 62 years (IQR = 51–75) and a median duration of their disease of 18 days (IQR = 12–28) were included in the study. At follow-up, the mortality rate was 27% (n = 71). Age and discharge CRS-R total score were independent predictors in a Cox proportional hazards model with death (yes/no) as the dependent variable. According to the GOSE interviews, most patients were either dead (n = 71; 27%), in a vegetative state (n = 28; 11%) or had a severe disability (n = 124; 47%), whereas only a few patients showed a moderate disability (n = 18; 7%) or a good recovery (n = 23; 9%) 1 year after discharge. Age, non-traumatic etiology, discharge CRS-R total score and length of stay independently predicted whether the outcome was good or poor at follow-up. Conclusion Age was an important predictor for outcome at one-year follow-up, which might be due to altered brain plasticity and more comorbidities in elderly subjects. In addition, the present study demonstrated that the CRS-R total score at discharge might be more important for the prediction of one-year outcome than the initial assessment upon admission.

Predicting outcome in disorders of consciousness: A mega‐analysis

“…Some recent large-scale clinical trials and a meta-analysis concluded that younger patients recover more frequently. 6,17,31,32 We were unable to confirm this Cumulative incidence (%) finding in the overall sample. However, our additional analysis revealed that older patients die earlier and more frequently than younger patients.…”

Validity of the Early Functional Ability scale (EFA) among critically ill patients undergoing early neurological rehabilitation

“…At the end of early rehabilitation, the length of stay and the type of discharge (e.g., nursing care, returning home) were determined. Finally, the Glasgow Outcome Scale-extended (GOSE) was assessed 1 year after discharge from early rehabilitation via telephone interviews (for further details, see [ 9 ]).…”

Outcomes of Neurorehabilitation Amongst Patients with Prolonged Disorders of Consciousness

“…Their result showed those patients who had MCS (Minimally Conscious State) upon admission showed a better outcome after discharge and were more likely to recover within one-year post-injury in terms of their level of consciousness, unlike the patients who suffered UWS (Unresponsive Wakefulness Syndrome) since Day 1 of admission. (10) Data on the effect of neurorehabilitation on the degree of level of consciousness in patients experiencing brain-related injuries remains largely unexplored and is still under study.…”