Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2020; 8(12): 2520-2529
Published online Jun 26, 2020. doi: 10.12998/wjcc.v8.i12.2520
Recovery from prolonged disorders of consciousness: A dual-center prospective cohort study in China
Wei-Guan Chen, Ran Li, Ye Zhang, Jian-Hui Hao, Ju-Bao Du, Ai-Song Guo, Wei-Qun Song
Wei-Guan Chen, Ran Li, Ye Zhang, Jian-Hui Hao, Ju-Bao Du, Wei-Qun Song, Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
Wei-Guan Chen, Ai-Song Guo, Department of Rehabilitation Medicine, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
Author contributions: Chen WG participated in study design, drafted the manuscript, was involved in data collection, and assisted with data analysis; Li R, Zhang Y, and Hao JH were involved in data collection and assisted with data analysis; Du JB and Guo AS were involved with data collection; Song WQ participated in design and supervision of the study; all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81371194 and No. 81873723.
Institutional review board statement: The study was approved by the ethics committee of Xuan Wu hospital according to the guidelines of the Helsinki declaration (1964 and 2000).
Informed consent statement: All study participants, or their legal guardian, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
STROBE statement: The authors have read the STROBE Statement, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wei-Qun Song, MD, Doctor, Department of Rehabilitation Medicine, Xuan Wu Hospital, Capital Medical University, No 45, Changchun Street, Xicheng District, Beijing 100053, China. songwq66@126.com
Received: December 30, 2019
Peer-review started: December 30, 2019
First decision: April 1, 2020
Revised: April 24, 2020
Accepted: May 20, 2020
Article in press: May 20, 2020
Published online: June 26, 2020
Abstract
BACKGROUND

Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness (DoC). Data are lacking regarding the long-term outcomes of those patients in China. It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.

AIM

To present the preliminary results of a DoC cohort.

METHODS

This was a two-center prospective cohort study of inpatients with vegetative state (VS)/unresponsive wakefulness syndrome (UWS). The study outcomes were the recovery from VS/UWS to minimally conscious state (MCS) and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years. The patients were evaluated using the Glasgow coma scale, coma recovery scale-revised, and Glasgow outcome scale. The endpoint of follow-up was recovery of full consciousness or death. The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline.

RESULTS

The study population included 93 patients (62 VS/UWS and 31 MCS). The post-injury interval range was 28-634 d. Median follow-up was 20 mo (interquartile range, 12-37 mo). At the endpoint, 33 transitioned to an emergence from MCS or full consciousness, eight had a locked-in syndrome, and there were 35 patients remaining in a VS/UWS and 11 in an MCS. Seven (including one locked-in syndrome) patients (7.5%) died within 12 mo of injury. Compared with the unresponsive group (n = 52) at 12 mo, the responsive group (n = 41) had a higher proportion of males (87.8% vs 63.5%, P = 0.008), shorter time from injury (median, 40.0 d vs 65.5 d, P = 0.006), higher frequency of vascular etiology (68.3% vs 38.5%, P = 0.007), higher Glasgow coma scale score at admission (median, 9 vs 6, P < 0.001), higher coma recovery scale-revised score at admission (median, 9 vs 2.5, P < 0.001), at 1 mo (median, 14 vs 5, P < 0.001), and at 3 mo (median, 20 vs 6, P < 0.001), lower frequency of VS/UWS (36.6% vs 90.0%, P < 0.001), and more favorable Glasgow outcome scale outcome (P < 0.001).

CONCLUSION

Patients with severe DoC, despite having strong predictors of poor prognosis, might recover consciousness after a prolonged time of rehabilitation. An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.

Keywords: Brain injury, Disorders of consciousness, Behavioral assessment, Coma recovery scale-revised, Prospective cohort study, Neurorehabilitation

Core tip: Data are lacking regarding the long-term outcomes of patients with disorders of consciousness (DoC) in China. This was a two-center prospective cohort study of inpatients with prolonged DoC for up to 6 years, included 93 patients (62 vegetative state/unresponsive wakefulness syndrome and 31 minimally conscious state). The results showed that patients with severe DoC, despite having strong predictors of poor prognosis, might recover consciousness after a prolonged time of rehabilitation.