Life expectancy and median survival time in the permanent vegetative state

The authors studied life expectancy and risk factors for mortality of perso ns in the vegetative state (VS), The study participants were 1,021 Californ ia patients in the VS during 1981-1996, Because of the large sample size, t he authors were able to use multivariate methods to assess the effect of se veral risk factors on mortality. The authors found a strong secular trend i n infant mortality, with rates in the mid-1990s being only one third of tho se in the early 1980s (P < 0.01), A smaller secular trend was observed for children aged 2-10 years and none for older patients. The mortality risk fo r older patients fell by approximately 8% for each year since the onset of the VS. The need for gastrostomy feeding was associated with a substantiall y higher risk, especially for infants and older patients (P < 0.01). Ventil ator dependence also appeared to be a risk factor. On the basis of recent m ortality rates, life expectancy in the VS is frequently higher than has gen erally been thought, For example, it is 10.5 additional years (+/- 2 years) for a 15-year-old patient who has been in the VS for 1 year, and 12.2 year s for a 15-year-old patient who has been in the VS for 4 years. (C) 1999 by Elsevier Science Inc. All rights reserved.