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J Head Trauma Rehabil. 2014 Sep-Oct;29(5):E31-43. doi: 10.1097/HTR.0000000000000017.

Rate of disorders of consciousness in a prospective population-based study of adults with traumatic brain injury.

Author information

1
Research Department, Sunnaas Rehabilitation Hospital, Nesodden, Norway (Drs Løvstad and Schanke and Ms Hauger); Department of Psychology, University of Oslo, Oslo, Norway (Drs Løvstad and Schanke); Departments of Physical Medicine and Rehabilitation (Drs Andelic and Røe) and Radiology (Dr Jerstad), Oslo University Hospital, Oslo, Norway; Department of Physical Medicine and Rehabilitation, Sørlandet Hospital, Kristiansand, Norway (Dr Knoph); Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway (Dr Anke); Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway (Dr Anke); Department of Physical Medicine and Rehabilitation, Trondheim University Hospital, Trondheim, Norway (Dr Skandsen); Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway (Dr Skandsen); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts (Dr Giacino); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Giacino); and Faculty of Medicine, University of Oslo, Oslo, Norway (Dr Røe).

Abstract

OBJECTIVE:

Establish rate of disorders of consciousness (DOC) and course of recovery in adults who have sustained severe traumatic brain injury (sTBI).

SETTING:

Four Norwegian neurosurgical departments.

PARTICIPANTS:

Vegetative or minimally conscious patients.

DESIGN:

Prospective, longitudinal population-based study of adults with sTBI with follow-ups at 3, 12, and 24-36 months postinjury.

MAIN MEASURES:

Coma Recovery Scale-Revised, Glasgow Coma Scale, Extended Glasgow Outcome Scale, and Disability Rating Scale.

RESULTS:

Three months postinjury, 2% of the sTBI population remained in a vegetative or minimally conscious state, reduced by the half after 1 year, corresponding to average annual age-adjusted incidence rates of DOC of 0.09 per 100 000 3 months post-sTBI. At 3 and 12 months, the incidence was 0.06 and 0.01 per 100 000 for the vegetative state and 0.03 and 0.04 per 100 000 for the minimally conscious state. Diagnostic categorization was stable between 12 and 24-36 months, although clinically relevant improvements were observed in minimally conscious patients.

CONCLUSION:

The data suggest that prolonged DOC is rare following sTBI in Norway, contrary to the commonly held belief that improvements in intensive care treatment have resulted in an increased incidence of DOC. Prolonged DOC was associated with severity of injury, subcortical lesions, and diffuse axonal injury.

PMID:
24413075
DOI:
10.1097/HTR.0000000000000017
[Indexed for MEDLINE]

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