TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, 260, Jungang-ro, Dogok-ri, Yangpyeong-eup, Yangpyeong-gun, Gyeonggi-do, 12564, South Korea.
Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul University College of Medicine, Seoul, South Korea.
BMC Neurol. 2020 May 20;20(1):198. doi: 10.1186/s12883-020-01758-5.
We investigated the clinical course of patients with prolonged disorders of consciousness (PDoC), predictors of emergence from PDoC (EDoC), and the temporal dynamics of six neurobehavior domains based on the JFK Coma Recovery Scale-Revised (CRS-R) during the recovery.
A total of 50 traumatic and non-traumatic patients with PDoC were enrolled between October 2014 and February 2017. A retrospective analysis of the clinical findings and neurobehavioral signs was conducted using standardized methodology such as CRS-R. The findings were used to investigate the incidence and predictors of EDoC and determine the cumulative pattern of neurobehavioral recovery at 6 months, 1 year, and 2 years post-injury.
The results showed that 46% of the subjects emerged from PDoC after 200 median days (64-1197 days) of injury onset. The significant predictors of EDoC included minimally conscious state (MCS) (vs. vegetative state), higher auditory, communication, arousal, total CRS-R scores, shorter lag time post-injury, and the absence of intra-axial lesions. In terms of cumulative recovery of motor and communication signs in patients who emerged from PDoC, 39 and 32% showed EDoC at 6 months post-injury, and 88 and 93% exhibited EDoC at 2 years post-injury, respectively.
Nearly half of the patients with PDoC recovered consciousness during inpatient rehabilitation. MCS, shorter lag time, the absence of intra-axial lesions, higher auditory, communication, arousal, and total CRS-R scores were important predictors for EDoC. Motor scores in the early stage of recovery and communication scores after prolonged intervals contributed to the higher levels of cumulative EDoC.
我们研究了持续性意识障碍（PDoC）患者的临床病程、从 PDoC 中苏醒（EDoC）的预测因素，以及基于 JFK 昏迷恢复量表修订版（CRS-R）的六个神经行为域在恢复过程中的时间动态。
2014 年 10 月至 2017 年 2 月期间，共纳入 50 例创伤性和非创伤性 PDoC 患者。使用标准化方法（如 CRS-R）对临床发现和神经行为体征进行回顾性分析。根据这些发现，研究了 EDoC 的发生率和预测因素，并确定了损伤后 6 个月、1 年和 2 年的神经行为恢复累积模式。
结果显示，46%的受试者在损伤后 200 天（64-1197 天）中位数后从 PDoC 中苏醒。EDoC 的显著预测因素包括最小意识状态（MCS）（与植物状态相比）、较高的听觉、交流、觉醒、总 CRS-R 评分、较短的损伤后潜伏期以及无脑内病变。对于从 PDoC 中苏醒的患者的运动和交流迹象的累积恢复，39%和 32%分别在损伤后 6 个月时出现 EDoC，88%和 93%分别在损伤后 2 年时出现 EDoC。
近一半的 PDoC 患者在住院康复期间恢复了意识。MCS、较短的潜伏期、无脑内病变、较高的听觉、交流、觉醒和总 CRS-R 评分是 EDoC 的重要预测因素。早期恢复的运动评分和长时间间隔后的交流评分有助于累积 EDoC 的更高水平。
