Very long-term outcomes in children admitted in a disorder of consciousness following severe traumatic brain injury.

Abstract

OBJECTIVES\nTo investigate functional outcomes and state of consciousness at 1-year and >2 years post-injury in children who sustained a traumatic brain injury (TBI) and were in a disorder of consciousness (DOC), either Vegetative State (VS) or Minimally Conscious State (MCS), upon admission to inpatient rehabilitation.\n\n\nDESIGN\nRetrospective chart review SETTING: Pediatric inpatient rehabilitation unit PARTICIPANTS: 37 children (2-18 years) admitted to inpatient rehabilitation with admission scores on the Cognitive and Linguistic Scale (CALS) <30 INTERVENTIONS: Not applicable MAIN OUTCOME MEASURES: Glasgow Outcome Scale- Extended, Pediatric Revision (GOS-E Peds); state of consciousness based on previously established guidelines RESULTS: At admission, 16 children were in VS (43.2%) and 21 (56.8%) were in MCS. Children admitted in VS had significantly longer time from injury to inpatient rehabilitation admission, lower CALS admission scores, were more likely to be in a DOC >28 days, and had greater disability at both follow-up time points. At 1-year follow-up, 3 patients were in VS, 7 were in MCS, and 27 had emerged from MCS. By most recent follow-up (>2 years), 2 more patients emerged from MCS. Across the cohort, GOS-E Peds scores at 1-year ranged from VS (GOS-E Peds=7) to upper moderate disability (GOS-E Peds=3). Most patients were functioning in the lower severe disability category (GOS-E Peds=6) at 1-year (43.2%) and most recent follow-up (43.2%). Twenty-seven patients (73.0%) showed stable GOS-E Peds scores between the 2 time-points, 6 (16.2%) improved, and 4 (10.8%) died.\n\n\nCONCLUSIONS\nWhile a majority of patients emerged from a DOC by 1-year post-injury, most continued to display notable functional impairment at 1-year follow-up that persisted to most recent follow-up. A small subset displayed important improvements between 1-year and most recent follow-up (2 patients emerged; 6 patients showed improvement in GOS-E Peds scores).