Outcome of Persistent Vegetative State Following Hypoxic or Traumatic Brain Injury in Children and Adolescents

Abstract

Persistent vegetative state (PVS, apallic syndrome) has become a significant medical and social problem. The outcome of young people with PVS is a matter of great interest. Therefore, we analysed the outcome of 127 children and adolescents who were in PVS for at least 30 days following traumatic (n = 82) or hypoxic (n = 45) brain injury.

After 19 months of follow-up, 84 % of the patients of the traumatic brain injury (TBI) group, but only 55 % of the hypoxic brain injury (HBI) group had left PVS (p < 0.001). The TBI patients regained consciousness earlier. Later than 9 months post trauma less than 5 % of the patients of both groups left PVS. Hypoxic brain injury patients had a higher incidence of seizures (p = 0.01) and a higher seizure frequency. They had significantly more complications like pneumonia, gastrointestinal disturbance or myositis ossificans (= heterotopic ossification). Posttraumatic hyperthermia and autonomic dysfunctions were correlated with worse outcome in the TBI group, but not in the HBI group. Thirteen patients (16 %) with TBI became independent in everyday life versus only two (4 %) with HBI.

These results underline the important contribution of hypoxia in severe and permanent brain impairment. They also may help to establish the prognosis of children in PVS.

Key words

Brain injury - Children - Epilepsy - Cerebral hypoxia - Ischemia - Persistent vegetative state