Abstract
Early and goal-directed management of complications and comorbidities is imperative to facilitate neurorecovery and to optimize outcomes of disorders of consciousness (DoC). This is the first large retrospective cohort study on the primary medical and neurological complications and comorbidities in persons with DoC. A total of 146 patients admitted to a specialized inpatient DoC rehabilitation program from 1 January 2014 to 31 October 2018 were included. The incidences of those conditions since their initial brain injuries were reviewed per documentation. They were categorized into reversible causes of DoC, confounders and mimics, and other medical/neurological conditions. The common complications and comorbidities included pneumonia (73.3%), pain (75.3%), pressure ulcers (70.5%), oral and limb apraxia (67.1%), urinary tract infection (69.2%), and 4-limb spasticity (52.7%). Reversible causes of DoC occurred very commonly. Conditions that may confound the diagnosis of DoC occurred at surprisingly high rates. Conditions that may be a source of pain occurred not infrequently. Among those that may diminish or confound the level of consciousness, 4.8 ± 2.0 conditions were identified per patient. In conclusion, high rates of various complications and comorbidities occurred in persons with DoC. Correcting reversible causes, identifying confounders and mimics, and managing general consequences need to be seriously considered in clinical practice.
Highlights
Severe and extensive injury to the brain may result in various degrees of alteration in the level of consciousness [1]
This study aims at reporting the primary medical and neurological complications and comorbidities from a clinical practice perspective in a specialized disorders of consciousness (DoC) rehabilitation program
This is a retrospective review study based on existing documentations in the electronic medical record (EMR) of all patients admitted to a specialized DoC rehabilitation program in a free-standing rehabilitation hospital from 1 January 2014 to 31 October 2018
Summary
Severe and extensive injury to the brain may result in various degrees of alteration in the level of consciousness [1]. Patients with disorders of consciousness (DoC) are clinically classified along a spectrum of severity ranging from coma to minimally conscious state (MCS) [1]. This patient population is often immobile and unable to communicate, which makes them susceptible to various medical and neurological complications and comorbidities. Some of these conditions are suggested to suppress and mask the expression of consciousness. Conditions that are uncommon but easy to identify in the general brain injury population may become common and difficult to identify in the DoC population
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