IBIA – DoC-SIG multi-centre longitudinal study on clinical and neurophysiological prognostic markers in prolonged disorders of consciousness: a one-year follow-up

Background and aims: Accurate prognosis in patients with Disorders of Consciousness (DoC) is challenging, but necessary for defining appropriate care pathways 1-3. The present multi-centre, prospective study performed by the Special Interest Group on DoC of the International Brain Injury Association is aimed at identifying predictors for one-year clinical outcome. Methods: 12 specialized medical institutions enrolled patients in prolonged unresponsive wakefulness syndrome/ vegetative state (UWS/VS) 4 or in minimally conscious state (MCS) 5 with time post-injury (TPI) ≤3 months. Demographic, anamnestic, clinical and neurophysiological data were collected at study entry. Clinical follow-up was performed at 12 months post-injury and patients who improved (i.e. recovering from UWS/VS to MCS, and from UWS/VS or MCS to full consciousness) were compared with those who did not (i.e. with unchanged diagnosis or died). Results: A convenience sample of 147 patients was enrolled (44 women; mean age: 49.4±19.9 years; mean TPI: 59.6±25.2 days; UWS/VS=71, MCS=76; traumatic=55, vascular=56, anoxic=36). At the 12-month evaluation, 71 patients (48%) had improved their diagnosis and 71 (48%) did not (4% dropped out). Logistic and LASSO regression analyses on 134 patients showed that lower age, shorter TPI and presence of EEG reactivity to eye opening and closing at study entry predicted improvement in diagnosis at 12 months post-onset (all p<.05). Conclusion: Multimodal assessment could provide valuable information for prognostication in patients with prolonged DoC. This international project would encourage standardization of diagnostic and prognostic procedures in patients with DoC.