Department of Acquired Brain Injury, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
Neurology Unit, Santa Maria Della Pietà General Hospital, Nola, Italy.
Brain Inj. 2021 Jan 5;35(1):1-7. doi: 10.1080/02699052.2020.1861652. Epub 2020 Dec 17.
: to assess overall clinical complexity of patients with acquired disorders of consciousness (DoC) in vegetative state/unresponsive wakefulness syndrome (VS/UWS) vs. minimally conscious state- MCS) and in different etiologies.. Multi-center cross-sectional observational study.: 23 intensive neurorehabilitation units.: 264 patients with DoC in the post-acute phase: VS/UWS = 141, and MCS = 123 due to vascular (n = 125), traumatic (n = 83) or anoxic (n = 56) brain injury.: Coma Recovery Scale-Revised, and Disability Rating Scale (DRS); presence of medical devices (e.g., for eating or breathing); occurrence and severity of medical complications.: patients in DoC, and particularly those in VS/UWS, showed severe overall clinical complexity. Anoxic patients had higher overall clinical complexity, lower level of responsiveness/consciousness, higher functional disability, and higher needs of medical devices. Vascular patients had worse premorbid clinical comorbidities. The two etiologies showed a comparable rate of MC, higher than that observed in traumatic etiology.: overall clinical complexity is significantly higher in VS/UWS than in MCS, and in non-traumatic vs. traumatic etiology. These findings could explain the worse clinical evolution reported in anoxic and vascular etiologies and in VS/UWS patients and contribute to plan patient-tailored care and rehabilitation programmes.
评估获得性意识障碍(DoC)患者的整体临床复杂性,包括处于植物状态/无反应觉醒综合征(VS/UWS)与最小意识状态(MCS)的患者,以及不同病因的患者。多中心横断面观察性研究。 23 个强化神经康复单位。 264 名处于急性后阶段的 DoC 患者:VS/UWS = 141 例,MCS = 123 例,分别归因于血管性(n = 125)、创伤性(n = 83)或缺氧性(n = 56)脑损伤。昏迷恢复量表修订版(CRS-R)和残疾评定量表(DRS);存在医疗设备(例如,用于进食或呼吸);医疗并发症的发生和严重程度。处于 DoC 的患者,特别是处于 VS/UWS 的患者,表现出严重的整体临床复杂性。缺氧性患者的整体临床复杂性更高,意识和反应能力更低,功能残疾程度更高,对医疗设备的需求更高。血管性患者的发病前临床合并症更严重。这两种病因的 MC 发生率可比,高于创伤性病因。 总体临床复杂性在 VS/UWS 中显著高于 MCS,在非创伤性病因中显著高于创伤性病因。这些发现可以解释在缺氧性和血管性病因以及 VS/UWS 患者中报告的更差的临床转归,并有助于制定针对患者的护理和康复计划。