Outcome of Persistent Vegetative State Following Hypoxic or Traumatic Brain Injury in Children and Adolescents

Abstract

Persistent vegetative state (PVS, apallic syndrome) has become a significant medical and social problem. The outcome of young people with PVS is a matter of great interest. Therefore, we analysed the outcome of 127 children and adolescents who were in PVS for at least 30 days following traumatic (n = 82) or hypoxic (n = 45) brain injury. After 19 months of follow-up, 84% of the patients of the traumatic brain injury (TBI) group, but only 55% of the hypoxic brain injury (HBI) group had left PVS (p < 0.001). The TBI patients regained consciousness earlier. Later than 9 months post trauma less than 5% of the patients of both groups left PVS. Hypoxic brain injury patients had a higher incidence of seizures (p = 0.01) and a higher seizure frequency. They had significantly more complications like pneumonia, gastrointestinal disturbance or myositis ossificans (= heterotopic ossification). Posttraumatic hyperthermia and autonomic dysfunctions were correlated with worse outcome in the TBI group, but not in the HBI group. Thirteen patients (16%) with TBI became independent in everyday life versus only two (4%) with HBI. These results underline the important contribution of hypoxia in severe and permanent brain impairment. They also may help to establish the prognosis of children in PVS.

Predictors of outcome following acquired brain injury in children

“…Research suggests that children who experience an anoxic or hypoxic/ischemic brain injury experience worse outcomes than those with TBI. Heindl and Laub [1996] found that children who sustained hypoxic/ischemic injury were less likely to leave the persistent vegetative state, had higher incidences of seizures and seizure frequency, and were less likely to become independent in everyday life than patients with TBI.…”

Predicting outcome after childhood brain injury: Figure 1:

“…33 An important cohort study involving children in a vegetative state on day 30 confirmed a much better prognosis for traumatic injuries than for those caused by hypoxia-ischemia. 34 Our inability to identify individual children making betterthan-expected (or worse) recoveries greatly complicates research in this area. 35 Motor recoveries after traumatic brain injury can be good, but can lead one to underestimate or not recognize late psychological and psychiatric morbidity, resulting in the re-examination of mild traumatic brain injury in children.…”

Serum Biomarkers after Traumatic and Hypoxemic Brain Injuries: Insight into the Biochemical Response of the Pediatric Brain to Inflicted Brain Injury

“…When compared with children with noninflicted TBI (nTBI), children with iTBI have a worse outcome when adjusting for age and severity of the injury [Beers et al, 2004;Keenan et al, 2006]. The degree of disability after iTBI is more similar to that after hypoxic-ischemic brain injury than after nTBI [Heindl et al, 1996].…”