Life expectancy of children in vegetative and minimally conscious states

Life expectancy of children in vegetative and minimally conscious states

Strauss DJ; Ashwal S; Day SM; Shavelle RM

Pediatric Neurology

2000

Child; Female; Male; Logistic Models; Survival Analysis; Risk Factors; Multivariate Analysis; Odds Ratio; adolescent; Preschool; Non-U.S. Gov't; Human; Support; Gastrostomy/mortality; Life Expectancy; Brain Injuries/mortality; Enteral Nutrition/mortality; Persistent Vegetative State/mortality

We determined estimates of survival in children, 3-15 years of age, in the vegetative state (VS) (n = 564), immobile minimally conscious state (MCS) (n = 705), and mobile MCS (n = 3,806). Data were extracted from the annual Client Development Evaluation Reports of the California Department of Developmental Services between 1988 and 1997 using the operational definitions for these three states on the basis of 15 descriptive behavioral categories. Patients were also categorized according to the following four etiologies: acquired (traumatic and nontraumatic) brain injury; perinatal/genetic; degenerative; and unknown/undetermined. The percentage of patients surviving 8 years was 63%, 65%, and 81%, for the VS, immobile MCS, and mobile MCS, respectively. Children in the VS and MCSs with acquired brain injury had lower mortality rates and those with degenerative diseases the highest mortality rates. We observed little difference in survival between patients in the VS and immobile MCS, suggesting that the presence of consciousness is not a critical variable in determining life expectancy. Furthermore, survival was much greater for patients in the mobile MCS than for those in the immobile MCS, suggesting that mobility is more important in predicting survival than the level of consciousness.

2000

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