SEARCHCROSS-SECTIONALneurology, epidemiology

cross-sectional·neurology, epidemiology, public health, internal medicine·PMC10662977

Prevalence of the Minimally Conscious State Among Institutionalized Patients in the Netherlands

Neurology · 5 authors, 1 centre

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TL;DR

This nationwide cross-sectional study estimated the prevalence of institutionalized patients in a minimally conscious state (MCS) in the Netherlands. The central result is a prevalence of 0.2–0.3 per 100,000 Dutch inhabitants.

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This descriptive cross-sectional study surveyed all Dutch hospitals, specialized rehabilitation facilities, and nursing homes to identify patients with a prolonged disorder of consciousness (pDoC) on September 15, 2021. Patient level of consciousness was verified using the Coma Recovery Scale-Revised (CRS-R). Among 49 verified patients with pDoC, 32 were confirmed to be in MCS. The calculated nationwide prevalence of institutionalized patients in MCS was 0.2–0.3 per 100,000 Dutch inhabitants. Limitations include potential exclusion of patients cared for at home and possible underestimation of consciousness level due to single assessments or interfering factors. The study's findings provide essential epidemiological data to inform and organize pDoC care in the Netherlands.

STUDY TYPE

cross-sectional

SPECIALTY

neurology

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ORIGINAL PAPER

PMC10662977

Prevalence of the Minimally Conscious State Among Institutionalized Patients in the Netherlands

Neurology

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ABSTRACT

Abstract Background and Objectives The minimally conscious state (MCS) is a prolonged disorder of consciousness (pDoC) and one of the most severe outcomes of acquired brain injury. Prevalence data are scarce. The aim of this study was to establish the nationwide point prevalence of institutionalized patients in MCS in the Netherlands. Methods This was a descriptive cross-sectional study in which all 86 Dutch hospitals, all 5 specialized pDoC rehabilitation facilities, and all 274 nursing homes were asked whether they were treating patients with a pDoC on the point prevalence date of September 15, 2021. Each patient's legal representative provided informed consent for their inclusion. Patient level of consciousness was verified using the Coma Recovery Scale-Revised (CRS-R) in a single assessment session performed in the facility of residence by an experienced physician. Data on patient demographics, etiology, level of consciousness, facility of residence, and clinical status were collected from a questionnaire by the treating physician. The prevalence of institutionalized patients in MCS of per 100,000 members of the Dutch population was calculated, based on actual census data. Results Seventy patients were reported to have a pDoC, of whom 6 were excluded. The level of consciousness was verified for 49 patients while for 15, it could not be verified. Of the patients verified, 38 had a pDoC, of whom 32 were in MCS (mean age 44.8 years, 68.8% male). The prevalence of institutionalized patients in MCS is 0.2–0.3 per 100,000 Dutch inhabitants. Traumatic brain injury was present in 21 of 32 patients (65.6%). Specialized pDoC rehabilitation was received by 17 of 32 patients (53%), with the rest admitted to nursing homes. The most frequent signs of consciousness on the CRS-R were visual pursuit, reproducible movement to command, and automatic motor response. Discussion This nationwide study revealed a low prevalence of institutionalized patients in MCS in the Netherlands. These findings are now being used to organize pDoC care in this country.

CITATION EXPORT

Berno UH Overbeek, Willemijn S van Erp, Henk J Eilander et al.. Prevalence of the Minimally Conscious State Among Institutionalized Patients in the Netherlands. Neurology. (2023). https://doi.org/10.1212/WNL.0000000000207820

AUTHORS

5 · 1 CENTRES

Berno UH Overbeek, Willemijn S van Erp, Henk J Eilander, Raymond TCM Koopmans, Jan CM Lavrijsen

1From the Department of Primary and Community Care (B.U.H.O., W.S.v.E., H.J.E., R.T.C.M.K., J.C.M.L.), Radboud University Medical Center, Research Institute of Medical Innovation; Kalorama (B.U.H.O.), Beek-Ubbergen; Azora (B.U.H.O.), Terborg; Accolade Zorg (W.S.v.E.), Bosch en Duin; Libra Rehabilitation & Audiology (W.S.v.E.), Tilburg; and Joachim and Anna, Center for Specialized Geriatric Care (R.T.C.M.K.), Nijmegen, the Netherlands.