Prevalence of persistent vegetative state compared to recovery, disability, and death in subjects with severe traumatic brain injury: A meta-analysis.

Abstract

The persistent vegetative state has drawn considerable attention since it is the poorest result apart from mortality in subjects with severe traumatic brain injury. This meta-analysis was performed to evaluate its prevalence compared to recovery, disability, and death 6months post severe traumatic brain injury. A systematic-literature search up to May 2020 was performed and 19 studies were detected with 10368 subjects. They contained data about the subject's status 6months post severe traumatic brain injury (recovery, disability, persistent vegetative state, and death). Odds ratio (OR) with 95% confidence intervals (CIs) was calculated comparing the prevalence of persistent vegetative state to that of recovery, disability, and death; 6months post severe traumatic brain injury using the dichotomous method with a random- or fixed-effect model. Significantly higher prevalence was found of recovery (OR, 0.08; 95% CI, 0.03-0.20, P<.001); disability (OR, 0.09; 95% CI, 0.06-0.15, P<.001); and death (OR, 0.07; 95% CI, 0.04-0.11, P<.001) compared to the prevalence of persistent vegetative state. The prevalence of persistent vegetative state was variable over time. Also, the prevalence of persistent vegetative states in developing countries was much higher than in developed countries. However, persistent vegetative state is the poorest result apart from mortality in subjects with severe traumatic brain injury. Its prevalence is lower than the recovery, disability, and death even in developing counties with its lower healthcare services. The prevalence was variable over time and higher in developing countries. This relationship forces us to recommend improving healthcare services to the extent that a persistent vegetative state could be avoided as much as possible.