Prevalence of the Minimally Conscious State in Institutionalized Patients in the Netherlands
Berno U.H. Overbeek, Willemijn S. van Erp, Henk J. Eilander, Raymond T.C.M. Koopmans, Jan C.M. Lavrijsen
19 October 2023Background and objectives
The Minimally Conscious State (MCS) is a long-term disorder of consciousness (pDoC) and one of the most serious consequences of acquired brain injury. Prevalence data are scarce. The aim of this study was to determine the national point prevalence of institutionalized patients at MCS in the Netherlands.
Methods
This was a descriptive cross-sectional study in which all 86 Dutch hospitals, all 5 specialized pDoC rehabilitation centers, and all 274 nursing homes were asked whether they were treating patients with a pDoC at the point prevalence date of September 15, 2021. Each patient's legal representative gave informed consent for their admission. The patient's level of consciousness was verified using the Coma Recovery Scale-Revised (CRS-R) in a single assessment session conducted at the residence by an experienced physician. Data on patient demographics, etiology, level of consciousness, place of residence, and clinical status were collected from a questionnaire by the treating physician. The prevalence of institutionalized patients in MCS per 100,000 members of the Dutch population was calculated on the basis of actual census data.
Results
Seventy patients were reported with a pDoC, of whom 6 were excluded. The level of consciousness was verified for 49 patients, while it could not be verified for 15. Of the verified patients, 38 had a pDoC, of whom 32 had MCS (mean age 44.8 years, 68.8% male). The prevalence of institutionalized patients in MCS is 0.2-0.3 per 100,000 Dutch inhabitants. Traumatic brain injury was present in 21 of the 32 patients (65.6%). Specialized pDoC rehabilitation was received by 17 of the 32 patients (53%), while the rest were admitted to nursing homes. The most common signs of consciousness on the CRS-R were visual pursuit, reproducible movement to command, and automatic motor response.
Discussion
This national study showed that there is a low prevalence of institutionalized patients with MCS in the Netherlands. These findings are now being used to organize pDoC care in this country.
