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Abstract
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BACKGROUND AND OBJECTIVES: The minimally conscious state (MCS) is a prolonged disorder of consciousness (pDoC) and one of the most severe outcomes of acquired brain injury. Prevalence data are scarce. The aim of this study was to establish the nationwide point prevalence of institutionalized patients in MCS in the Netherlands.
METHODS: This was a descriptive cross-sectional study in which all 86 Dutch hospitals, all five specialized pDoC rehabilitation facilities, and all 274 nursing homes were asked whether they were treating patients with a pDoC on the point prevalence date of September 15, 2021. Each patient's legal representative provided informed consent for their inclusion. Patient level of consciousness was verified using the Coma Recovery Scale-Revised (CRS-R) in a single assessment session performed in the facility of residence by an experienced physician. Data on patient demographics, etiology, level of consciousness, facility of residence, and clinical status were collected from a questionnaire by the treating physician. A prevalence figure of institutionalized of in MCS of per 100,000 members of the Dutch population was calculated, based on actual census data.
RESULTS: Seventy patients were reported to have a pDoC, of whom six were excluded. The level of consciousness was verified for 49 patients, while for 15 it could not be verified. Of the patients verified, 38 had a pDoC, of whom 32 were in MCS (mean age 44.8 years, 68.8% male). The prevalence of institutionalized patients in MCS is 0.2-0.3/100,000 Dutch inhabitants. Traumatic brain injury was present in 21/32 (65.6%) of these patients. Specialized pDoC rehabilitation was received by 17/32 (53%) of patients, with the rest admitted to nursing homes. The most frequent signs of consciousness on the CRS-R were visual pursuit, reproducible movement to command, and an automatic motor response.
DISCUSSION: This nationwide study revealed a low prevalence of institutionalized patients in MCS in the Netherlands. These findings are now being used to organize pDoC care in this country.
Language: en |