PT  - JOURNAL ARTICLE
AU  - Estraneo, Anna
AU  - Fiorenza, Salvatore
AU  - Magliacano, Alfonso
AU  - Formisano, Rita
AU  - Mattia, Donatella
AU  - Grippo, Antonello
AU  - Romoli, Anna Maria
AU  - Angelakis, Efthymios
AU  - Cassol, Helena
AU  - Thibaut, Aurore
AU  - Gosseries, Olivia
AU  - Lamberti, Gianfranco
AU  - Noé, Enrique
AU  - Bagnato, Sergio
AU  - Edlow, Brian L.
AU  - Chatelle, Camille
AU  - Lejeune, Nicolas
AU  - Veeramuthu, Vigneswaran
AU  - Bartolo, Michelangelo
AU  - Toppi, Jlenia
AU  - Zasler, Nathan
AU  - Schnakers, Caroline
AU  - Trojano, Luigi
AU  - ,
TI  - Multicenter prospective study on predictors of short-term outcome in disorders of consciousness
AID  - 10.1212/WNL.0000000000010254
DP  - 2020 Sep 15
TA  - Neurology
PG  - e1488--e1499
VI  - 95
IP  - 11
4099  - http://n.neurology.org/content/95/11/e1488.short
4100  - http://n.neurology.org/content/95/11/e1488.full
SO  - Neurology2020 Sep 15; 95
AB  - 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.APG=anterior-posterior gradient; AUC=area under the curve; BCa=bias corrected and accelerated; CI=confidence interval; CRS-R=Coma Recovery Scale–Revised; DoC=Disorders of consciousness; DoC-SIG=Special Interest Group on Disorders of Consciousness; DRS=Disability Rating Scale; DS=diffuse slowing; ERP=event-related potential; IBIA=International Brain Injury Association; IPS=intermittent photic stimulation; LASSO=least absolute shrinkage and selection operator; LV=low voltage; MCS=minimally conscious state; MiA=mildly abnormal; MoA=moderately abnormal; NCS-R=Nociception Coma Scale–Revised; SEP=somatosensory evoked potential; VIF=variance inflation factor; VS/UWS=vegetative state/unresponsive wakefulness syndrome