title: Development of a simple score to predict outcome for unresponsive wakefulness syndrome.
abstract: BACKGROUND
  Accurate assessment of prognosis for patients with unresponsive wakefulness syndrome (UWS; formerly vegetative state) may help clinicians and families guide the type and intensity of therapy; however, there is no suitable and accurate means to predict the outcome so far. We aimed to develop a simple bedside scoring system to predict the likelihood of awareness recovery in patients with UWS.
  
  
  METHODS
  We prospectively enrolled 56 patients (age range 10 to 73 years) with UWS 3 to 12 weeks post-onset. We collected demographic data and performed neurological, serological and neurophysiological tests at study entry. Each patient received a one year follow-up, during which awareness recovery was assessed by experienced physicians on the basis of clinical criteria. Univariate and multivariable analyses were employed to assess the relationships between predictors and awareness recovery.
  
  
  RESULTS
  A total of 56 participants were included in the study; of these, 24 patients recovered awareness, 3 with moderate disabilities, 8 with severe disabilities, 12 were in a minimally conscious state, and 1 died after recovery. During the study, 23 patients remained in UWS and 9 died in UWS. Motor response, type of brain injury, electroencephalogram reactivity, sleep spindles and N20 were shown to be independent predictors for awareness recovery. Based on their coefficients in the model, we assigned these predictors with 1 point each and created a 5-point score for prediction of awareness recovery. The resulting score showed good predictive accuracy in the derivation cohort. The area under the receiver operating characteristic curve for the score was 0.918 with 87.50% sensitivity.
  
  
  CONCLUSIONS
  This simple bedside prognostic score can be used to predict the probability of awareness recovery in UWS, thus provide families and clinicians with useful outcome information.
authors.forename: Xiao-Gang
authors.initials: XG
authors.lastname: Kang
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Dong
authors.initials: D
authors.lastname: Wei
authors.forename: Xiao-Xia
authors.initials: XX
authors.lastname: Xu
authors.forename: Rui
authors.initials: R
authors.lastname: Zhao
authors.forename: Yun-Yun
authors.initials: YY
authors.lastname: Jing
authors.forename: Ying-Ying
authors.initials: YY
authors.lastname: Su
authors.forename: Li-Ze
authors.initials: LZ
authors.lastname: Xiong
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
authors.forename: Wen
authors.initials: W
authors.lastname: Jiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications; D002648:Child; D004569:Electroencephalography; D005071:Evoked Potentials / Q000502:physiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D064926:Neurophysiological Monitoring / Q000379:methods*; D018458:Persistent Vegetative State / Q000145:classification* / Q000503:physiopathology; D010751:Phosphopyruvate Hydratase / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D010751:Phosphopyruvate Hydratase