Consciousness trajectories and functional independence after acute brain injury in children with prolonged disorder of consciousness

Abstract

Prolonged disorders of consciousness (PDoC) refer to a state of unconsciousness that persists for a minimum of 4 weeks following an acute brain injury. While there is an increasing amount of evidence regarding the management and prognosis for adults, research on the assessment of consciousness trajectories (i.e. how consciousness has changed over time) and related factors in children has been limited. In this retrospective cohort study, the consciousness trajectories and functional independence in children with PDoC after acute brain injury were investigated.

This study included 152 cases from 1st January 2014 to 31st June 31 2021. The most common cause of brain injury was intracranial infection (caused by bacteria, viruses, or fungi), followed by trauma and hereditary/metabolism, hypoxic–ischemic encephalopathy (a type of brain damage caused by a lack of oxygen to the brain before or shortly after birth), and inflammation. The rates of consciousness recovery at 3 months, 6 months, and 12 months post-injury were 21.6%, 36.6%, and 48.5% respectively, and most children regained consciousness around 4 months after injury.

Factors included onset age of 3 years or older, the cause of brain trauma, electroencephalogram (EEG) grade IV or below, and the absence of bilateral impairments in the posterior cingulate (controlling state of arousal) and basal ganglia (responsible primarily for motor control) were identified as predictors of consciousness recovery. Additionally, EEG grade IV or below, the absence of bilateral impairments in the frontal lobes (high cognitive function), and occipital lobes (responsible for visual perception) were associated with favorable functional outcome.