THE VEGETATIVE AND MINIMALLY CONSCIOUS STATES - A COMPARISON OF CLINICAL-FEATURES AND FUNCTIONAL OUTCOME

To compare the vegetative (VS) and minimally conscious states (MCS) wi th regard to the incidence of specific clinical features and differenc es in functional outcome across the first year post injury. It was hyp othesized that patients diagnosed with MCS on admission to rehabilitat ion would have more favorable outcomes at 1 year post injury relative to patients diagnosed with VS and that this difference would be more p ronounced for traumatic (TBI) versus nontraumatic brain injury (NTBI). Design: Retrospective analysis of clinical findings collected using a standardized methodology (ie, Coma Recovery Scale). Findings were uti lized to determine diagnosis and functional outcome at 1, 3, 6, and 12 months post injury. Setting: Acute and extended care brain injury reh abilitation hospital. Patients: 104 patients (62 male, 42 female; mean age = 37 years; mean weeks post injury to admission = 10) with severe TBI or NTBI (VS = 55; MCS = 49) admitted to a rehabilitation-based co ma intervention program. Results: Functional outcome at 3, 6, and 12 m onths post injury was significantly more favorable for patients diagno sed with MCS relative to those with an admitting diagnosis of VS, and this difference was greatest for patients in MCS following TBI. Visual tracking and motor agitation were found to occur in VS but were of lo w frequency in comparison to MCS. Conclusions: In patients with severe disorders of consciousness, those diagnosed with MCS show more contin uous improvement and attain significantly more favorable outcomes by 1 year post injury than those diagnosed with VS. The presence of specif ic clinical features, particularly visual tracking, may contribute add itional information to differential diagnosis in patients whose level of behavioral responsiveness is severely diminished.