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
ARTICLE HIGHLIGHTS
Research 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). The most important concern for DoC patients and their family is prognosis because it is central to the decisions regarding medical treatment and eventual rehabilitation therapy, and profound ethical issues are involved. In China, the accessibility to proper management services for DoC patients is a major issue.

Research motivation

Data are lacking regarding the long-term outcomes of DoC patients in China. It is necessary to study the long-term outcomes of patients in prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.

Research objectives

The study aimed to assess the recovery rate of the inpatients with prolonged DoC after the standard follow-up, hoping to investigate the factors associated with a higher likelihood to recover consciousness at rehabilitation facilities in China and further our understanding of the rehabilitation potential of the most severely affected patients with DoC.

Research 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 (GCS), 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.

Research results

The study population included 93 patients (62 VS/UWS and 31 MCS). 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. Compared with the unresponsive group, the responsive group had a higher proportion of males, shorter time from injury, higher frequency of vascular etiology, higher Glasgow coma scale score and coma recovery scale-revised score at admission, lower frequency of VS/UWS, and more favorable Glasgow outcome scale outcome.

Research conclusions

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.

Research perspectives

This preliminary study indicates that establishing a rehabilitation-based registry for patients with severe DoC after brain injury is feasible and probably relevant to improve patient management.