Abstract
BackgroundThe present study intended to analyze the outcome of patients with severe brain injury one-year after discharge from early rehabilitation.MethodsEarly neurological rehabilitation patients admitted to intensive or intermediate care units and discharged between June 2018 and May 2020 were screened for eligibility. The level of consciousness was evaluated using the Coma Recovery Scale-Revised (CRS-R) upon admission and at discharge. At one-year follow-up, the outcome was assessed with the Glasgow Outcome Scale-extended (GOSE). Demographical and clinical data collected during inpatient rehabilitation were used to predict the outcome 1 year after discharge.ResultsTwo hundred sixty-four patients (174 males, 90 females) with a median age of 62 years (IQR = 51–75) and a median duration of their disease of 18 days (IQR = 12–28) were included in the study. At follow-up, the mortality rate was 27% (n = 71). Age and discharge CRS-R total score were independent predictors in a Cox proportional hazards model with death (yes/no) as the dependent variable. According to the GOSE interviews, most patients were either dead (n = 71; 27%), in a vegetative state (n = 28; 11%) or had a severe disability (n = 124; 47%), whereas only a few patients showed a moderate disability (n = 18; 7%) or a good recovery (n = 23; 9%) 1 year after discharge. Age, non-traumatic etiology, discharge CRS-R total score and length of stay independently predicted whether the outcome was good or poor at follow-up.ConclusionAge was an important predictor for outcome at one-year follow-up, which might be due to altered brain plasticity and more comorbidities in elderly subjects. In addition, the present study demonstrated that the CRS-R total score at discharge might be more important for the prediction of one-year outcome than the initial assessment upon admission.
Highlights
The present study intended to analyze the outcome of patients with severe brain injury one-year after discharge from early rehabilitation
Patients admitted to neurological rehabilitation are frequently still in an altered state of consciousness, including the unresponsive wakefulness syndrome (UWS; patients show no behavioral signs of self-related or environmental awareness) and the minimally conscious state (MCS; patients show inconsistent but reproducible signs of awareness) [3, 4]
Age proved to be an independent predictor of mortality and outcome 1 year after discharge from post-acute rehabilitation
Summary
The present study intended to analyze the outcome of patients with severe brain injury one-year after discharge from early rehabilitation. The acute-care treatment of these patients is often followed by inpatient neurological rehabilitation. Boltzmann et al BMC Neurology (2022) 22:30 stabilized at this point of treatment, most patients are still in need of intensive care, including mechanical ventilation and monitoring of vital parameters. Patients who are in MCS 1 month post-onset are more likely to recover within the first year than patients in UWS [2, 5]. Within both categories, patients with traumatic brain injuries have a better prognosis than patients with non-traumatic brain injuries [2]
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