Practice guideline update recommendations summary: Disorders of consciousness Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research
Practice guideline update recommendations summary: Disorders of consciousness Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology; the American Congress of Rehabilitation Medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research
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DOI：
10.1212/wnl.0000000000005926
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发表时间：
2018-09-04
期刊：
影响因子：
9.9
通讯作者：
Armstrong, Melissa J.
中科院分区：
文献类型：
--
作者：
Giacino, Joseph T.;Katz, Douglas I.;Armstrong, Melissa J.
目的更新1995年美国神经病学学会（AAN）关于持续性植物人状态的实践参数和2002年关于最低意识状态（MCS）的病例定义，为延长性意识障碍（DoC）患者提供护理建议。方法建议基于系统评价证据、相关证据、护理原则和根据AAN 2011流程手册修订的德尔菲共识流程的推论。临床医生应识别和治疗混杂条件，优化唤醒，并进行一系列标准化评估，以提高成人和儿童长期DoC （B级）的诊断准确性。临床医生应告知家属，对于成人，MCS （vs植物人状态[vs]/无反应性觉醒综合征[UWS]）和创伤（vs非创伤）病因与更有利的结果相关（B级）。当预后差时，必须讨论长期护理（A级），承认预后并非普遍差（B级）。结构MRI、SPECT和昏迷恢复量表-修订版可以帮助预测成人（B级）；没有测试显示可以提高儿童预后的准确性。疼痛总是应该被评估和治疗（B级），并讨论支持治疗方法的证据（B级）。临床医生应为创伤性VS/UWS或MCS（损伤后4-16周）的成人患者开金刚烷胺（100- 200mg bid），以加速功能恢复并减少恢复早期的残疾（B级）。有关儿童的家庭咨询应承认，儿童的自然康复史、预后和治疗尚未确定（B级）。最近的证据表明，术语慢性VS/UWS应该取代永久性VS，并指定持续时间（B级）。还包括其他建议。
ObjectiveTo update the 1995 American Academy of Neurology (AAN) practice parameter on persistent vegetative state and the 2002 case definition on minimally conscious state (MCS) and provide care recommendations for patients with prolonged disorders of consciousness (DoC).MethodsRecommendations were based on systematic review evidence, related evidence, care principles, and inferences using a modified Delphi consensus process according to the AAN 2011 process manual, as amended.RecommendationsClinicians should identify and treat confounding conditions, optimize arousal, and perform serial standardized assessments to improve diagnostic accuracy in adults and children with prolonged DoC (Level B). Clinicians should counsel families that for adults, MCS (vs vegetative state [VS]/unresponsive wakefulness syndrome [UWS]) and traumatic (vs nontraumatic) etiology are associated with more favorable outcomes (Level B). When prognosis is poor, long-term care must be discussed (Level A), acknowledging that prognosis is not universally poor (Level B). Structural MRI, SPECT, and the Coma Recovery Scale-Revised can assist prognostication in adults (Level B); no tests are shown to improve prognostic accuracy in children. Pain always should be assessed and treated (Level B) and evidence supporting treatment approaches discussed (Level B). Clinicians should prescribe amantadine (100-200 mg bid) for adults with traumatic VS/UWS or MCS (4-16 weeks post injury) to hasten functional recovery and reduce disability early in recovery (Level B). Family counseling concerning children should acknowledge that natural history of recovery, prognosis, and treatment are not established (Level B). Recent evidence indicates that the term chronic VS/UWS should replace permanent VS, with duration specified (Level B). Additional recommendations are included.