Medical complications and advance medical decision-making in the minimally conscious state.

IF 1.5 4区医学 Q4 NEUROSCIENCES

Brain injury Pub Date : 2025-03-21 Epub Date: 2024-11-12 DOI:10.1080/02699052.2024.2425737

Berno U H Overbeek, Willemijn S van Erp, Henk J Eilander, Raymond T C M Koopmans, Jan C M Lavrijsen

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引用次数: 0

Abstract

Objectives: Medical complications occur frequently in MCS and influence advance medical decision-making. This study aimed to report on medical complications and advance medical decision-making in a nationwide group of MCS patients.

Methods: In this descriptive cross-sectional study, clinical and advance medical decision-making characteristics were collected in a survey, completed by the treating physician.

Results: The MCS population consisted of 32 patients: 65.6% traumatic etiology, 68.8% male. Patients had a median of five complications: hypertonia/spasticity (81.3%) and pneumonia (50.0%) occurred most frequently. Most patients had curative goals: three patients had a fully curative treatment scenarios, 29 a curative scenario with ≥ 1 treatment restrictions, two a palliative and two a symptomatic scenario. Conversations about advance medical decision-making were complicated by disputes with next of kin, inability to evaluate medical treatment because of medical instability, next of kin not being ready to discuss medical treatment, or a treatment scenario explicitly based on requests of next of kin.

Conclusion: Medical complications are common in MCS patients and advance medical decision making was complicated. This legitimates realization of specialized care across acute, post-acute and long-term care. Further longitudinal research into advance medical decision-making is recommended.

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微意识状态下的医疗并发症和预先医疗决策。

目的：医疗并发症经常出现在 MCS 中，并影响预先医疗决策。本研究旨在报告全国范围内一组 MCS 患者的医疗并发症和预先医疗决策情况：在这项描述性横断面研究中，由主治医生填写调查问卷，收集临床和预先医疗决策特征：结果：MCS 群体由 32 名患者组成：结果：MCS 患者共 32 人：65.6% 为创伤性病因，68.8% 为男性。患者并发症的中位数为五种：高张力/痉挛（81.3%）和肺炎（50.0%）最为常见。大多数患者的目标是治愈：3 名患者的治疗方案是完全治愈，29 名患者的治疗方案是治愈，但治疗限制≥ 1 项，2 名患者的治疗方案是缓解，2 名患者的治疗方案是对症。与近亲发生争执、因病情不稳定而无法评估治疗方案、近亲尚未准备好讨论治疗方案或治疗方案明确基于近亲的要求，这些都使有关预先医疗决策的对话变得复杂：结论：医疗并发症在慢性病患者中很常见，预先医疗决策也很复杂。这就需要在急性期、急性期后和长期护理中实现专业护理。建议对预先医疗决策进行进一步的纵向研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Brain injury 医学-康复医学

CiteScore

3.50

自引率

5.30%

发文量

148

审稿时长

12 months

期刊介绍： Brain Injury publishes critical information relating to research and clinical practice, adult and pediatric populations. The journal covers a full range of relevant topics relating to clinical, translational, and basic science research. Manuscripts address emergency and acute medical care, acute and post-acute rehabilitation, family and vocational issues, and long-term supports. Coverage includes assessment and interventions for functional, communication, neurological and psychological disorders.