Acquired brain injury; Ethics; Long-term care; Rehabilitation; Vegetative state
Abstract :
[en] Introduction: Patients in a vegetative state/unresponsive wakefulness syndrome (VS/UWS) open their eyes spontaneously, but show only reflexive behavior. Although VS/UWS is one of the worst possible outcomes of acquired brain injury, its prevalence is largely unknown. This study's objective was to map the total population of hospitalized and institutionalized patients in VS/UWS in the Netherlands: prevalence, clinical characteristics, and treatment limitations. Methods: Nationwide point prevalence study on patients in VS/UWS at least 1month after acute brain injury in hospitals, rehabilitation centers, nursing homes, institutions for people with intellectual disability, and hospices; diagnosis verification by a researcher using the Coma Recovery Scale-revised (CRS-r); gathering of demographics, clinical characteristics, and treatment limitations. Results: We identified 33 patients in VS/UWS, 24 of whose diagnoses could be verified. Patients were on average 51years old with a mean duration of VS/UWS of 5years. The main etiology was hypoxia sustained during cardiac arrest and resuscitation. More than 50% of patients had not received rehabilitation services. Most were given life-sustaining treatment beyond internationally accepted prognostic boundaries regarding recovery of consciousness. Seventeen (39%) of 41 patients presumed to be in VS/UWS were found to be at least minimally conscious. Conclusions: Results translate to a prevalence of 0.1 to 0.2 hospitalized and institutionalized VS/UWS patients per 100,000 members of the general population. This small figure may be related to the legal option to withhold or withdraw life-sustaining treatment, including artificial nutrition and hydration. On the other hand, this study shows that in certain cases, physicians continue life-prolonging treatment for up to 25years. Patients have poor access to rehabilitation and are at substantial risk for misdiagnosis.
Lavrijsen, Jan C.M.; Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, Netherlands
Vos, Pieter E.; Department of Neurology, Singeland Ziekenhuis, Doetinchem, Netherlands
Bor, Hans; Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, Netherlands
Laureys, Steven ; Université de Liège - ULiège > GIGA Consciousness: Coma Science Group
Koopmans, Raymond T.; Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, Netherlands, Waalboog Foundation, Joachim and Anna, Centre for Specialised Geriatric Care, Nijmegen, Netherlands
Language :
English
Title :
The vegetative state: Prevalence, misdiagnosis, and treatment limitations
Publication date :
2015
Journal title :
Journal of the American Medical Directors Association
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