The vegetative and minimally conscious states: A comparison of clinical features and functional outcome
The vegetative and minimally conscious states: A comparison of clinical features and functional outcome
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DOI：
10.1097/00001199-199708000-00005
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发表时间：
1997-08-01
影响因子：
2.4
通讯作者：
Kalmar, K
中科院分区：
文献类型：
--
作者：
Giacino, JT;Kalmar, K
比较植物人状态（VS）和最低意识状态（MCS）受伤后第一年内特定临床特征的发生率和功能结局的差异。据推测，入院康复时诊断为MCS的患者在损伤后1年时相对于诊断为VS的患者具有更有利的结局，并且这种差异在创伤性（TBI）与非创伤性脑损伤（NTBI）中更为明显。设计：采用标准化方法（即昏迷恢复量表）对收集的临床结果进行回顾性分析。研究结果用于确定损伤后1、3、6和12个月的诊断和功能结局。单位：急性和扩展护理脑损伤康复医院。患者：104例重度TBI或NTBI（VS = 55; MCS = 49）患者（62例男性，42例女性;平均年龄= 37岁;受伤后至入院的平均周数= 10）接受了基于康复的昏迷干预计划。结果如下：相对于入院诊断为VS的患者，诊断为MCS的患者在损伤后3、6和12个月的功能结局明显更有利，并且这种差异在TBI后MCS患者中最大。发现视觉跟踪和运动激动发生在VS中，但与MCS相比频率较低。结论：在严重意识障碍的患者中，诊断为MCS的患者表现出更持续的改善，并在损伤后1年获得比诊断为VS的患者更有利的结果。特定临床特征的存在，特别是视觉跟踪，可能有助于其行为反应水平严重降低的患者的鉴别诊断的额外信息。
To compare the vegetative (VS) and minimally conscious states (MCS) with regard to the incidence of specific clinical features and differences in functional outcome across the first year post injury. It was hypothesized that patients diagnosed with MCS on admission to rehabilitation would have more favorable outcomes at 1 year post injury relative to patients diagnosed with VS and that this difference would be more pronounced for traumatic (TBI) versus nontraumatic brain injury (NTBI). Design: Retrospective analysis of clinical findings collected using a standardized methodology (ie, Coma Recovery Scale). Findings were utilized to determine diagnosis and functional outcome at 1, 3, 6, and 12 months post injury. Setting: Acute and extended care brain injury rehabilitation hospital. Patients: 104 patients (62 male, 42 female; mean age = 37 years; mean weeks post injury to admission = 10) with severe TBI or NTBI (VS = 55; MCS = 49) admitted to a rehabilitation-based coma intervention program. Results: Functional outcome at 3, 6, and 12 months post injury was significantly more favorable for patients diagnosed with MCS relative to those with an admitting diagnosis of VS, and this difference was greatest for patients in MCS following TBI. Visual tracking and motor agitation were found to occur in VS but were of low frequency in comparison to MCS. Conclusions: In patients with severe disorders of consciousness, those diagnosed with MCS show more continuous improvement and attain significantly more favorable outcomes by 1 year post injury than those diagnosed with VS. The presence of specific clinical features, particularly visual tracking, may contribute additional information to differential diagnosis in patients whose level of behavioral responsiveness is severely diminished.