Objectives

To investigate functional outcomes and state of consciousness at 1 year and ≥2 years postinjury in children who sustained a traumatic brain injury and were in a disorder of consciousness (DOC), either vegetative state (VS) or minimally conscious state (MCS), upon admission to inpatient rehabilitation.

Design

Retrospective chart review.

Setting

Pediatric inpatient rehabilitation unit.

Participants

Children aged 2-18 years (N=37) who were admitted to inpatient rehabilitation with admission scores <30 on the Cognitive and Linguistic Scale (CALS).

Interventions

Not applicable.

Main Outcome Measures

Glasgow Outcome Scale- Extended, Pediatric Revision (GOS-E Peds), and state of consciousness based on previously established guidelines.

Results

At admission, 16 children were in VS (43.2%) and 21 (56.8%) were in MCS. Children admitted in VS had a significantly longer time from injury to inpatient rehabilitation admission, lower CALS admission scores, were more likely to be in a DOC ≥28 days, and had greater disability at both follow-up time points. At the 1-year follow-up, 3 patients were in VS, 7 were in MCS, and 27 had emerged from MCS. By the time of the most recent follow-up (≥2y), 2 more patients had emerged from MCS. Across the cohort, GOS-E Peds scores at 1 year ranged from VS (GOS-E Peds, 7) to upper moderate disability (GOS-E Peds, 3). Most patients were functioning in the lower severe disability category (GOS-E Peds, 6) at 1 year (43.2%) and at the time of the most recent follow-up (43.2%). Twenty-seven patients (73.0%) showed stable GOS-E Peds scores between the 2 time points, 6 (16.2%) improved, and 4 (10.8%) were deceased.

Conclusions

Although a majority of patients emerged from a DOC by 1 year postinjury, most continued to demonstrate notable functional impairment at the 1-year follow-up that persisted to the most recent follow-up. A small subset demonstrated important improvements between 1 year and the most recent follow-up (2 patients emerged, 6 patients showed improvement in GOS-E Peds scores).

中文翻译：

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严重创伤性脑损伤后意识障碍入院儿童的长期结局

目标

调查遭受创伤性脑损伤并处于意识障碍 (DOC)、植物状态 (VS) 或最小意识状态 (MCS) 的儿童在受伤后 1 年和 ≥ 2 年的功能结果和意识状态住院康复治疗。

设计

回顾性图表审查。

环境

儿科住院康复单位。

参与者

接受住院康复治疗的 2-18 岁儿童 (N=37)，认知和语言量表 (CALS) 的入院分数 <30。

干预措施

不适用。

主要观察指标

格拉斯哥结局量表 - 扩展、儿科修订 (GOS-E Peds) 和基于先前制定的指南的意识状态。

结果

入院时，16 名儿童处于 VS（43.2%），21 名（56.8%）处于 MCS。VS 入院的儿童从受伤到住院康复入院的时间显着延长，CALS 入院评分较低，更有可能在 DOC ≥28 天，并且在两个随访时间点都有更大的残疾。随访 1 年，VS 3 例，MCS 7 例，MCS 痊愈27 例。到最近一次随访（≥2 年）时，又有 2 名患者从 MCS 中出现。在整个队列中，1 年时的 GOS-E Peds 评分范围从 VS（GOS-E Peds，7）到中度残疾（GOS-E Peds，3）。大多数患者在 1 年 (43.2%) 和最近一次随访时 (43.2%) 都处于低严重残疾类别 (GOS-E Peds, 6)。27 名患者 (73.0%) 在 2 个时间点之间表现出稳定的 GOS-E Peds 评分，

结论

尽管大多数患者在受伤后 1 年从 DOC 中恢复过来，但大多数患者在 1 年的随访中继续表现出明显的功能障碍，并且一直持续到最近的随访。一小部分在 1 年和最近一次随访之间表现出重要的改善（2 名患者出现，6 名患者的 GOS-E Peds 评分有所改善）。