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.

摘要

目的：评估处于营养状态/无反应性清醒综合征（VS / UWS）与最低意识状态-MCS和不同病因的获得性意识障碍（DoC）患者的整体临床复杂性。

设计：多中心横截面观察研究。

地点：23个强化神经康复单元。

受试者：264例急性后DoC患者：VS / UWS = 141，由于血管（n = 125），外伤（n = 83）或缺氧（n = 56）脑损伤而导致的MCS = 123。

主要措施：修订后的昏迷恢复量表和残疾评定量表（DRS）；存在医疗设备（例如，用于进食或呼吸）；医疗并发症的发生和严重程度。

结果：DoC患者，特别是VS / UWS患者，表现出严重的整体临床复杂性。缺氧患者的整体临床复杂性较高，反应/意识水平较低，功能障碍较高，对医疗设备的需求也较高。血管疾病患者的合并症较严重。两种病因显示出可比的MC率，高于创伤病因中观察到的率。

结论：VS / UWS的总体临床复杂性显着高于MCS，以及非创伤性与创伤性病因学相比。这些发现可以解释在缺氧和血管病因学以及VS / UWS患者中报告的较差的临床进展，并有助于计划针对患者的护理和康复计划。