Article

Very severe traumatic brain injury may cause disorders of
consciousness in the form of coma, unresponsive wakefulness syndrome (also known
as vegetative state) or minimally conscious state.
Previous studies of outcome
for these patients largely pre-date the 2002 definition of minimally conscious
state. OBJECTIVES: To establish the numbers of patients with disorder of
consciousness at 3 weeks, 3 months and 1 year after severe traumatic brain
injury, and to relate conscious state 3 weeks after injury to outcomes at 1 year.
DESIGN: Multi-centre, prospective, observational study of severe traumatic brain
injury. INCLUSION CRITERIA: lowest (non-sedated) Glasgow Coma Scale 3-8 during
the first 24 h; requirement for neurosurgical intensive care; age 18-65 years;
alive 3 weeks after injury. Diagnosis of coma, unresponsive wakefulness syndrome,
minimally conscious state or emerged from minimally conscious state was based on
clinical and Coma Recovery Scale Revised assessments 3 weeks, 3 months and 1 year
after injury. One-year outcome was measured with Glasgow Outcome Scale Extended
(GOSE). RESULTS: A total of 103 patients was included in the study. Of these, 81%
were followed up to 1 year (76% alive, 5% dead). Three weeks after injury 36 were
in coma, unresponsive wakefulness syndrome or minimally conscious state and 11
were anaesthetized. Numbers of patients who had emerged from minimally conscious
state 1 year after injury, according to status at 3 weeks were: coma (0/6),
unresponsive wakefulness syndrome (9/17), minimally conscious state (13/13),
anaesthetized (9/11). Outcome at 1 year was good (GOSE > 4) for half of patients
in minimally conscious state or anaesthetized at 3 weeks, but for none of the
patients in coma or unresponsive wakefulness syndrome. These differences in
outcome were not revealed by prognostic predictions based on acute data.
CONCLUSION: Patients in minimally conscious state or anaesthetized 3 weeks after
injury have a better prognosis than patients in coma or unresponsive wakefulness
syndrome, which could not be explained by acute prognostic models.

Langue : ANGLAIS