Very prolonged unresponsive state following brain injury.
A study was made of patients suffering from a prolonged unconscious state following brain injury from road accidents, cardiac arrest, falls and post-operative unconsciousness after cardiac surgery. Seventeen patients (Group A) were admitted to Harzfeld Hospital several months after the injury in a state of continued unresponsiveness; 6 others (Group B) were admitted because of rehabilitation potential despite unconsciousness, or because of behaviour difficulties in their rehabilitation. The duration of unresponsiveness ranged from 3 months to 4 years. Observation and follow-up showed late neurologic recovery after 1 year or more in 6 subjects as shown by ability to swallow, improved posture of the head or trunk, limb movement and increased awareness. Five of the Group B subjects were discharged, 4 in a markedly improved state. Eleven of 17 unresponsive subjects of Group A died, and 6 remain alive in hospital, 2 significantly improved. The duration of hospital care was 12.8 months in Harzfeld Hospital, and a total of 21.9 months from the time of injury. Those who still survive in hospital have now a mean stay of 50 months. Complications, and implications for treatment are described and the attitude thought appropriate to the management of these long-term patients in the face of their families is discussed in the light of our experience over 6 years.
D001930:Brain Injuries / Q000150:complications* / Q000523:psychology / Q000534:rehabilitation; D004185:Disability Evaluation; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D009460:Neurologic Examination; D011379:Prognosis; D013997:Time Factors; D014474:Unconsciousness