RT Journal Article
SR Electronic
T1 Multicenter prospective study on predictors of short-term outcome in disorders of consciousness
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e1488
OP e1499
DO 10.1212/WNL.0000000000010254
VO 95
IS 11
A1 Estraneo, Anna
A1 Fiorenza, Salvatore
A1 Magliacano, Alfonso
A1 Formisano, Rita
A1 Mattia, Donatella
A1 Grippo, Antonello
A1 Romoli, Anna Maria
A1 Angelakis, Efthymios
A1 Cassol, Helena
A1 Thibaut, Aurore
A1 Gosseries, Olivia
A1 Lamberti, Gianfranco
A1 Noé, Enrique
A1 Bagnato, Sergio
A1 Edlow, Brian L.
A1 Chatelle, Camille
A1 Lejeune, Nicolas
A1 Veeramuthu, Vigneswaran
A1 Bartolo, Michelangelo
A1 Toppi, Jlenia
A1 Zasler, Nathan
A1 Schnakers, Caroline
A1 Trojano, Luigi
A1 ,
YR 2020
UL http://n.neurology.org/content/95/11/e1488.abstract
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