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.
OBJECTIVE
To investigate the long-term (2-15 years) functional outcome of children and young adults who received an early intensive neurorehabilitation programme (EINP) after a prolonged period of unconsciousness due to severe brain injury; to differentiate 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).


METHODS
One hundred and forty-five patients, who were admitted to EINP between December 1987 and January 2001.


METHODS
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 were deceased. The mean DRS-score of the surviving patients was 6.8 (SD = 6.6); the mean score on the GOSE was 4.5 (SD = 1.7). There was a significant difference in the outcome amongst traumatic and non-traumatic patients (t88 = 4.21; p < 0.01). The correlation between the DRS and the GOSE was high (Spearman rho = 0.85; p < 0.01), as well as the correlation between the categorized scores of the DRS and the GOSE (Spearman rho = 0.81; p < 0.01). The distribution of outcome scores on the DRScat is more diverse than on the GOSE. Especially item 7 of the DRS, measuring functional independence, showed considerable variance in discriminating between different outcome levels.


CONCLUSIONS
More patients with TBI than expected reached a (semi-) independent level of functioning, indicating a possible effect of EINP. Patients suffering from nTBI did not demonstrate these outcome levels. Only a few patients stayed in a vegetative state for more than a couple of years. In this cohort of severe brain-injured young people, the DRS offered the best investigative possibilities for long-term level of functioning.
Eilander
H J
HJ
Rehabilitation Centre Leijpark. Division Research, Project VLB-NAH, Tilburg. H.J.Eilander@hccnet.nl
Timmerman
R B W
RB
Scheirs
J G M
JG
Van Heugten
C M
CM
De Kort
P L M
PL
Prevo
A J H
AJ
D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D004522:Educational Status; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018458:Persistent Vegetative State / Q000209:etiology / Q000534:rehabilitation; D011379:Prognosis; D020127:Recovery of Function; D014474:Unconsciousness / Q000209:etiology* / Q000534:rehabilitation