Abstract
BackgroundThe prevalence of patients suffering from hypoxic brain damage is increasing. Long-term outcome data and prognostic factors for either poor or good outcome are lacking.MethodsThis retrospective study included 93 patients with hypoxic brain damage undergoing neurological early rehabilitation [length of stay: 108.5 (81.9) days]. Clinical data, validated outcome scales (e.g. Barthel Index—BI, Early Rehabilitation Index—ERI, Glasgow Coma Scale—GCS, Coma Remission Scale—CRS), neuroimaging data, electroencephalography (EEG) and evoked potentials were analyzed.Results75.3% had a poor outcome (defined as BI <50). 38 (40.9%) patients were discharged to a nursing care facility, 21 (22.6%) to subsequent rehabilitation, 17 (18.3%) returned home, 9 (9.7%) needed further acute-care hospital treatment and 8 (8.6%) died. Barthel Index on admission as well as coma length were strong predictors of outcome from hypoxic brain damage. In addition, duration of vegetative instability, prolongation of wave III in visual evoked potentials (flash VEP), theta and delta rhythm in EEG, ERI, GCS and CRS on admission were related to poor outcome. All patients with bilateral hypodensities of the basal ganglia belonged to the poor outcome group. Age had no independent influence on functional status at discharge.ConclusionsAs with other studies on neurological rehabilitation, functional status on admission turned out to be a strong predictor of outcome from hypoxic brain damage.
Highlights
The prevalence of patients suffering from hypoxic brain damage is increasing
Our results suggest that Glasgow Coma Scale (GCS) might serve as a prognostic variable in neurological early rehabilitation
Duration of vegetative instability was significantly longer in the poor outcome group. These results suggest that—besides functional ability tests such as Barthel index—coma length may be an indicator of brain damage severity and is linked to the outcomes
Summary
The prevalence of patients suffering from hypoxic brain damage is increasing. Called hypoxic–ischemic encephalopathy, is a severe consequence of global cerebral ischemia due to cardiac arrest [1] or other causes (e.g. hanging, strangulation, poisoning with carbon monoxide or near-drowning). Clinical trials showed that 27% of post-hypoxic coma patients regained consciousness within 28 days, 9% remained comatose or in an unresponsive wakefulness syndrome (UWS), and 64% died [3, 4]. In another prospective clinical study, 18.6% of patients stayed in an UWS [5]
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