Multi-center study on overall clinical complexity of patients with prolonged disorders of consciousness of different etiologies
Creators
- Estraneo A1
- Masotta O2
- Bartolo M3
- Pistoia F4
- Perin C5
- Marino S6
- Lucca L7
- Pingue V8
- Casanova E9
- Romoli A10
- Gentile S11
- Formisano R12
- Salvi GP13
- Scarponi F14
- De Tanti A15
- Bongioanni P16
- Rossato E17
- Santangelo A18
- Diana AR19
- Gambarin M20
- Intiso D21
- Antenucci R22
- Premoselli S23
- Bertoni M24
- De Bellis F25
- 1. Department of Acquired Brain Injury, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy; Neurology Unit, Santa Maria Della Pietà General Hospital, Nola, Italy.
- 2. Lab for DoC Study, Istituti Clinici Scientifici Maugeri IRCCS, SB S.p.A. Lab for DoC Study, Telese Terme, Italy.
- 3. Neurorehabilitation Unit, HABILITA Zingonia/Ciserano, Bergamo, Italy.
- 4. Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy.
- 5. Unità di Neuroriabilitazione Cognitiva, Istituti Clinici Zucchi, Carate Brianza, Italy.
- 6. IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy.
- 7. Unità di Riabilitazione Gravi Cerebrolesioni, Istituto S. Anna, Crotone, Italy.
- 8. Unità Medicina Riabilitativa Neuromotoria, Istituti Clinici Scientifici Maugeri IRCCS, SB S.p.A, Pavia, Italy.
- 9. Casa dei Risvegli Luca De Nigris, IRCCS Ospedale Maggiore, Bologna, Italy.
- 10. Department of Acquired Brain Injury, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.
- 11. Dip. di Riabilitazione, F.T. Camplani Clinica Ancelle Carità, Cremona, Italy.
- 12. Unità Post-Coma e di Ricerca Traslazionale, IRCCS, Fondazione Santa Lucia, Rome, Italy.
- 13. U.F. Riabilitazione Neuromotoria, Istituto Clinico Quarenghi, S. Pellegrino Terme, Italy.
- 14. Dip. di Neurologia - UGCA, Ospedale S. Giovanni Battista, Foligno, Italy.
- 15. Centro Cardinal Ferrari, S. Stefano Riabilitazione, Fontanellato di Parma, Italy.
- 16. Severe Acquired Brain Injuries Dept Section, Integrated Care Dept of Medical Specialties, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
- 17. Centro Medicina del Sonno, Ospedale Sacro Cuore Don Calabria, Verona, Italy.
- 18. Unit for Severe Acquired Brain Injuries, Rehabilitation Dept, Giuseppe Giglio Foundation, Cefalù, Italy.
- 19. Dip. Neuroscienze e Riabilitazione, Azienda Ospedaliera Brotzu, Cagliari, Italy.
- 20. Unità Medicina Fisica e Riabilitazione, Ospedale Riabilitativo Di Marzana, Verona, Italy.
- 21. Unità di Medicina Fisica e Neuroriabilitazione, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy.
- 22. Unità di Medicina Riabilitativa Intensiva, Ospedale Castel San Giovanni, Italy.
- 23. Struttura di Riabilitazione Neuromotoria, Presidio Ospedaliero Vimercate, Monza, Italy.
- 24. Presidio di Riabilitazione Neuromotoria, Azienda Socio Sanitaria Territoriale dei Sette Laghi, Cuasso Al Monte, Italy.
- 25. Dept. of Acquired Brain Injury, Fondazione Don Carlo Gnocchi, Sant'Angelo dei Lombardi, Italy.
Description
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.
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