Vegetative state in two Italian residential facilities: study of prognosis for subjects and related caregivers.

BACKGROUND

Vegetative state (VS) is a severe disturbance of consciousness, often caused by cerebral insults, with limited long-term prognosis data.

STUDY

OBJECTIVE

to provide a detailed picture of a cohort of patients treated at 2 long-term care facilities in Lombardy starting from 2014.

METHODS

Multicentric observational study. Subjects who met the diagnostic criteria for VS were admitted. A caregiver was identified for each patient and filled two questionnaires to evaluate quality of life (SF-36) and need for psychological support (FSQ-30).

RESULTS

The study included 146 patients (median age: 61.8 years at admission, 60.4 at the event that caused VS). Non-traumatic cerebral hemorrhage was the leading cause of VS (41%), followed by traumatic (19%) and anoxic brain injury (17%), and ischemic stroke (6.8%). The cumulative mortality was 10% at 1 year, 24% at 2 years, 43% at 5 years, 69% at 10 years, and 88% at 15 years after the event that caused VS, with age (HR 1.03) and ischemic stroke (HR 2.86) as risk factors. Among 24 caregivers, 50% had FSQ-30 score suggesting recommended psychological support (R area), 33% were in the SR area (strongly recommended), and 13% in the U area (urgent need). Females had worse FSQ-30 and SF-36 scores than males, particularly in the mental health index (median 60 vs. 74) and mental component scale (45.3 vs. 53.2).

CONCLUSIONS

Hemorrhages were found to be the most common cause of VS, differing from previous studies that identified trauma as the primary cause. Caregivers exhibited significant psychological distress.