Factors influencing recovery in a pediatric sample with disorders of consciousness: insights from an observational study

To estimate rates and time to reach emergence of consciousness from vegetative state/unresponsive wakefulness syndrome (VS/UWS), and explore factors associated with improved recovery in children and adolescents with disorders of consciousness (DoC) following severe traumatic and non-traumatic brain injury. Analytical, retrospective, cohort study. Clinical records of consecutively referred patients admitted in VS/UWS to a neurological rehabilitation institute in Argentina, between 2005 and 2021 were reviewed. Seventy children and adolescents were included in the analysis. A specialized 12-week rehabilitation program was administered, and emergence was defined by scores ≥44 points on the Western Neuro Sensory Stimulation Profile (WNSSP), sustained for at least 3 weeks on consecutive weekly evaluations. Emergence from VS/UWS to consciousness occurred within 5.4 (SD 2.6) weeks in almost one-third of patients. Multivariate Cox regression analysis showed emergence was significantly lower in patients with hypoxic ischemic encephalopathy compared to patients with other non-traumatic etiologies [HRadj 0.23 (95% CI 0.06–0.89); <i>p</i> = 0.03)]. Our findings reinforce growing evidence on the impact of etiology on DoC recovery in pediatric populations, ultimately influencing treatment and family-related decisions in child neurorehabilitation.

本研究旨在估算从植物状态/无反应觉醒综合征（Vegetative State/Unresponsive Wakefulness Syndrome, VS/UWS）中觉醒并恢复意识的比率与所需时长，并探讨儿童及青少年在遭受严重创伤性与非创伤性脑损伤后，罹患意识障碍（Disorders of Consciousness, DoC）后康复改善的相关影响因素。本研究为分析性回顾性队列研究。研究回顾了2005年至2021年间，阿根廷某神经康复机构收治的、连续转诊的以VS/UWS收入院的患者的临床病历，最终纳入70名儿童及青少年进行数据分析。所有受试者均接受为期12周的专业化康复干预方案；意识觉醒的判定标准为：在连续每周的评估中，西方神经感觉刺激概况（Western Neuro Sensory Stimulation Profile, WNSSP）评分≥44分且该状态持续至少3周。近三分之一的患者在5.4（标准差2.6）周内完成从VS/UWS到意识恢复的觉醒过程。多变量Cox回归分析显示，相较于其他非创伤性病因患者，缺氧缺血性脑病患者的意识觉醒率显著更低[校正后风险比HRadj=0.23，95%置信区间CI：0.06~0.89；P=0.03]。本研究结果进一步佐证了病因对儿科人群意识障碍康复的影响，该结论最终可为儿童神经康复领域的临床治疗决策及家庭相关考量提供参考依据。