Abstract：
BACKGROUND: Advances in medical care have increased survival in people with severe brain injuries and with that the number of survivors with prolonged disorders of consciousness (PDOC) has increased. In the literature, early intensive neurorehabilitation (EIN) for people with PDOC is recommended to achieve the best possible outcomes.
OBJECTIVE: To evaluate the frequency and extent of recovery of consciousness, mortality, complications, pain and discomfort, and medication during a nationwide EIN programme in people with PDOC after acquired brain injury. We hypothesized that level of consciousness would improve in half of people with PDOC.
METHODS: Prospective cohort study. People with PDOC aged 16 years and older admitted to the EIN department centralized in a single rehabilitation centre in the Netherlands (Libra Rehabilitation & Audiology) were included. The EIN delivers a subacute medical level of care and rehabilitation for a maximum duration of 14 weeks. The outcome measures were level of consciousness (CRS-R), mortality, number of complications, medication and pain/discomfort (NCS-R).
RESULTS: Of the 104 people included, 68 % emerged to a minimal conscious state with command-following or higher during EIN and 44 % regained consciousness. Mortality during EIN was 6 %, and 50 % of deaths followed a non-treatment decision or withdrawal of life-sustaining treatment. Almost all participants had at least 1 medical complication, leading to hospital readmission for 30 %. 73 % showed no pain or discomfort. During EIN, cardiovascular medication and analgesics were reduced by 15 %.
CONCLUSIONS: During the EIN programme, a large percentage of people with PDOC regained at least a minimal conscious state or even consciousness. These outcomes and the frequent medical complications in these people suggest that intensive specialized care should be offered to all people with PDOC. The outcomes of this study might help health professionals to better inform the families of people with PDOC about the short-term prognosis of PDOC.
UNASSIGNED: The Dutch Trial Register, NL 8138.
OBJECTIVE: To evaluate the frequency and extent of recovery of consciousness, mortality, complications, pain and discomfort, and medication during a nationwide EIN programme in people with PDOC after acquired brain injury. We hypothesized that level of consciousness would improve in half of people with PDOC.
METHODS: Prospective cohort study. People with PDOC aged 16 years and older admitted to the EIN department centralized in a single rehabilitation centre in the Netherlands (Libra Rehabilitation & Audiology) were included. The EIN delivers a subacute medical level of care and rehabilitation for a maximum duration of 14 weeks. The outcome measures were level of consciousness (CRS-R), mortality, number of complications, medication and pain/discomfort (NCS-R).
RESULTS: Of the 104 people included, 68 % emerged to a minimal conscious state with command-following or higher during EIN and 44 % regained consciousness. Mortality during EIN was 6 %, and 50 % of deaths followed a non-treatment decision or withdrawal of life-sustaining treatment. Almost all participants had at least 1 medical complication, leading to hospital readmission for 30 %. 73 % showed no pain or discomfort. During EIN, cardiovascular medication and analgesics were reduced by 15 %.
CONCLUSIONS: During the EIN programme, a large percentage of people with PDOC regained at least a minimal conscious state or even consciousness. These outcomes and the frequent medical complications in these people suggest that intensive specialized care should be offered to all people with PDOC. The outcomes of this study might help health professionals to better inform the families of people with PDOC about the short-term prognosis of PDOC.
UNASSIGNED: The Dutch Trial Register, NL 8138.
摘要：
背景：医疗护理的进展增加了严重脑损伤患者的生存率，并且长期意识障碍（PDOC）的幸存者数量增加了。在文学中,建议对患有PDOC的患者进行早期强化神经康复(EIN),以实现最佳结局.
目的：评估意识恢复的频率和程度，死亡率,并发症,疼痛和不适，以及在获得性脑损伤后患有PDOC的人在全国EIN计划中的药物治疗。我们假设一半的PDOC患者的意识水平会提高。
方法：前瞻性队列研究。包括16岁及以上的PDOC患者，他们被EIN部门集中在荷兰的一个康复中心（天秤座康复与听力学）。EIN提供亚急性医疗水平的护理和康复，最长持续时间为14周。结果测量为意识水平(CRS-R)，死亡率,并发症的数量，药物和疼痛/不适（NCS-R）。
结果：在包括的104人中，在EIN期间，有68％的人出现在最低意识状态，并具有命令跟随或更高的意识状态，而44％的人恢复了意识。EIN期间的死亡率为6%，50%的死亡是在做出非治疗决定或退出维持生命的治疗之后.几乎所有参与者都有至少1次医疗并发症，导致30%的医院再入院。73%无疼痛或不适。在EIN期间,心血管药物和镇痛药减少了15%.
结论：在EIN计划期间，大部分患有PDOC的人至少恢复了最低限度的意识状态甚至意识。这些结果以及这些人中常见的医疗并发症表明，应向所有PDOC患者提供重症专科护理。这项研究的结果可能有助于卫生专业人员更好地告知PDOC患者的家庭PDOC的短期预后。
■荷兰审判登记册，NL8138。
目的：评估意识恢复的频率和程度，死亡率,并发症,疼痛和不适，以及在获得性脑损伤后患有PDOC的人在全国EIN计划中的药物治疗。我们假设一半的PDOC患者的意识水平会提高。
方法：前瞻性队列研究。包括16岁及以上的PDOC患者，他们被EIN部门集中在荷兰的一个康复中心（天秤座康复与听力学）。EIN提供亚急性医疗水平的护理和康复，最长持续时间为14周。结果测量为意识水平(CRS-R)，死亡率,并发症的数量，药物和疼痛/不适（NCS-R）。
结果：在包括的104人中，在EIN期间，有68％的人出现在最低意识状态，并具有命令跟随或更高的意识状态，而44％的人恢复了意识。EIN期间的死亡率为6%，50%的死亡是在做出非治疗决定或退出维持生命的治疗之后.几乎所有参与者都有至少1次医疗并发症，导致30%的医院再入院。73%无疼痛或不适。在EIN期间,心血管药物和镇痛药减少了15%.
结论：在EIN计划期间，大部分患有PDOC的人至少恢复了最低限度的意识状态甚至意识。这些结果以及这些人中常见的医疗并发症表明，应向所有PDOC患者提供重症专科护理。这项研究的结果可能有助于卫生专业人员更好地告知PDOC患者的家庭PDOC的短期预后。
■荷兰审判登记册，NL8138。
