Children and young adults in a prolonged unconscious state after severe brain injury: long-term functional outcome as measured by the DRS and the GOSE after early intensive neurorehabilitation.
Eilander, H.J., Timmerman, R.B.W., Scheirs, J.G.M., van Heugten, C.M., de Kort, P.L.M., & Prevo, A.J.H.
1 January 2007Abstract
Objective
To investigate the long-term functional outcome (2-15 years) of children and young adults who received an early intensive neurorehabilitation program (EINP) after a prolonged period of unconsciousness due to severe brain injury; to distinguish between traumatic brain injury (TBI) and non-traumatic brain injury (nTBI); and to compare the results on two different outcome scales: the Disability Rating Scale (DRS) and the Glasgow Outcome Scale Extended (GOSE).
Subjugate
One hundred and forty-five patients, who were admitted to EINP between December 1987 and January 2001.
Outcome measures
The Post-Acute Level of Consciousness scale (PALOC-s), the DRS, including categorized scores (DRScat), and the GOSE.
Results
The long-term functional level of 90 patients could be determined, of whom 25 had died. The mean DRS score of the surviving patients was 6.8 (SD 1/4 6.6); the average score on the CISE was 4.5 (SD 1/4 1.7). There was a significant difference in the outcome between traumatic and non-traumatic patients (t(88) 1/4 4.21; p < 0.01). The correlation between the DRS and the GOSE was high (Spearman rho 1/4 0.85; p < 0.01), as was the correlation between the categorized scores of the DRS and the GOSE (Spearman rho 1/4 0.81; p < 0.01). The distribution of outcome scores on the DRScat is more diverse than on the GOSE. In particular, item 7 of the DRS, measuring functional independence, showed significant variation in distinguishing between different outcome levels.
Conclusions
More patients with TBI than expected achieved a (semi-)independent level of functioning, indicating a possible effect of EINP. Patients suffering from nTBI did not show these outcome levels. Only a few patients stayed in a vegetative state for more than a few years. In this cohort of young people with severe brain injury, the DRS offered the best research opportunities for long-term functioning.
Keywords
Consciousness, Children with Brain Injury, Functional Recovery, Long-Term Functioning, Minimal Conscious State, Neurorehabilitation, Severe Brain Injury, Vegetative State, Youth