Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies
Anna Estraneo, Orsola Masotta, Michelangelo Bartolo, Francesca Pistoia, C Perin, Silvia Marino, Lucia Francesca Lucca, Valeria Pingue, Emanuela Casanova, Anna Maria Romoli, Stéphanie Gentile, Rita Formisano, GP Salvi, F Scarponi, Antonio De Tanti, Paolo Bongioanni, Elena Rossato, A. Santangelo, AR Diana, Mattia Gambarin, Domenico Intiso, R Antenucci, S Premoselli, Michele Bertoni, Francesco De Bellis
Abstract
Aim: 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..Design: Multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 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.Main Measures: 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.Results: 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.Conclusion: 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.