Frédéric Faugeras1,2,3,4, Benjamin Rohaut1,2,3,4, Mélanie Valente3,4, Jacobo Sitt3,4, Sophie Demeret1, Francis Bolgert1, Nicolas Weiss1, Alexandra Grinea1, Clémence Marois1,3,4, Marion Quirins3,4, Athena Demertzi3,4, Federico Raimondo3,4, Damien Galanaud5,6, Marie-Odile Habert6,7,8, Denis Engemann3,4, Louis Puybasset6,9, Lionel Naccache1,2,3,4,6. 1. a AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurology , Paris , France. 2. b AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurophysiology , Paris , France. 3. c INSERM, U 1127 , Paris , France. 4. d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France. 5. e AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neuroradiology , Paris , France. 6. f Sorbonne Universités, UPMC Univ Paris 06 , Faculté de Médecine Pitié-Salpêtrière , Paris , France. 7. g AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Nuclear Medicine , Paris , France. 8. h Sorbonne Universités, UPMC Univ Paris 06 , CNRS, INSERM, Laboratoire d'Imagerie Biomédicale , Paris , France. 9. i AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Anesthesiology , Paris , France.
Abstract
BACKGROUND: The prognosis value of early clinical diagnosis of consciousness impairment is documented by an extremely limited number of studies, whereas it may convey important information to guide medical decisions. OBJECTIVE: We aimed at determining if patients diagnosed at an early stage (<90 days after brain injury) as being in the minimally conscious state (MCS) have a better prognosis than patients in the vegetative state/Unresponsive Wakefulness syndrome (VS/UWS), independent of care limitations or withdrawal decisions. METHODS: Patients hospitalized in ICUs of the Pitié-Salpêtrière Hospital (Paris, France) from November 2008 to January 2011 were included and evaluated behaviourally with standardized assessment and with the Coma Recovery Scale-Revised as being either in the VS/UWS or in the MCS. They were then prospectively followed until 1July 2011 to evaluate their outcome with the GOSE. We compared survival function and outcomes of these two groups. RESULTS: Both survival function and outcomes, including consciousness recovery, were significantly better in the MCS group. This difference of outcome still holds when considering only patients still alive at the end of the study. CONCLUSIONS: Early accurate clinical diagnosis of VS/UWS or MCS conveys a strong prognostic value of survival and of consciousness recovery.
BACKGROUND: The prognosis value of early clinical diagnosis of consciousness impairment is documented by an extremely limited number of studies, whereas it may convey important information to guide medical decisions. OBJECTIVE: We aimed at determining if patients diagnosed at an early stage (<90 days after brain injury) as being in the minimally conscious state (MCS) have a better prognosis than patients in the vegetative state/Unresponsive Wakefulness syndrome (VS/UWS), independent of care limitations or withdrawal decisions. METHODS:Patients hospitalized in ICUs of the Pitié-Salpêtrière Hospital (Paris, France) from November 2008 to January 2011 were included and evaluated behaviourally with standardized assessment and with the Coma Recovery Scale-Revised as being either in the VS/UWS or in the MCS. They were then prospectively followed until 1July 2011 to evaluate their outcome with the GOSE. We compared survival function and outcomes of these two groups. RESULTS: Both survival function and outcomes, including consciousness recovery, were significantly better in the MCS group. This difference of outcome still holds when considering only patients still alive at the end of the study. CONCLUSIONS: Early accurate clinical diagnosis of VS/UWS or MCS conveys a strong prognostic value of survival and of consciousness recovery.
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Authors: Julia Nekrasova; Mikhail Kanarskii; Ilya Borisov; Pranil Pradhan; Denis Shunenkov; Alexey Vorobiev; Maria Smirnova; Vera Pasko; Marina V Petrova; Elena Luginina; Igor Pryanikov Journal: Brain Sci Date: 2021-05-16