Vegetative state in two Italian residential facilities: study of prognosis for subjects and related caregivers.

Abstract

Background: Vegetative state (VS) is a severe disturbance of consciousness, often caused by cerebral insults, with limited long-term prognosis data.

Study objective: to provide a detailed picture of a cohort of patients treated at 2 long-term care facilities in Lombardy starting from 2014.

Methods: Multicentric observational study. Subjects who met the diagnostic criteria for VS were admitted. A caregiver was identified for each patient and filled two questionnaires to evaluate quality of life (SF-36) and need for psychological support (FSQ-30).

Results: The study included 146 patients (median age: 61.8 years at admission, 60.4 at the event that caused VS). Non-traumatic cerebral hemorrhage was the leading cause of VS (41%), followed by traumatic (19%) and anoxic brain injury (17%), and ischemic stroke (6.8%). The cumulative mortality was 10% at 1 year, 24% at 2 years, 43% at 5 years, 69% at 10 years, and 88% at 15 years after the event that caused VS, with age (HR 1.03) and ischemic stroke (HR 2.86) as risk factors. Among 24 caregivers, 50% had FSQ-30 score suggesting recommended psychological support (R area), 33% were in the SR area (strongly recommended), and 13% in the U area (urgent need). Females had worse FSQ-30 and SF-36 scores than males, particularly in the mental health index (median 60 vs. 74) and mental component scale (45.3 vs. 53.2).

Conclusions: Hemorrhages were found to be the most common cause of VS, differing from previous studies that identified trauma as the primary cause. Caregivers exhibited significant psychological distress.