Prognostic models for prolonged disorders of consciousness: an integrative review
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Cellular and Molecular Life Sciences
REVIEW
Prognostic models for prolonged disorders of consciousness: an integrative review Ming Song1,2 · Yi Yang3 · Zhengyi Yang1,2 · Yue Cui1,2 · Shan Yu1,2 · Jianghong He4 · Tianzi Jiang1,2,5,6,7 Received: 19 May 2019 / Revised: 23 March 2020 / Accepted: 30 March 2020 © Springer Nature Switzerland AG 2020
Abstract Disorders of consciousness (DoC) are acquired conditions of severe altered consciousness. During the past decades, some prognostic models for DoC have been explored on the basis of a variety of predictors, including demographics, neurological examinations, clinical diagnosis, neurophysiology and brain images. In this article, a systematic review of pertinent literature was conducted. We identified and evaluated 21 prognostic models involving a total of 1201 DoC patients. In terms of the reported accuracies of predicting the prognosis of DoC, these 21 models vary widely, ranging from 60 to 90%. Using improvement of consciousness level as favorable outcome criteria, we performed a quantitative meta-analysis, and found that the pooled sensitivity and specificity of the hybrid model that combined more than one technique were both superior to those of any single technique, including EEG and fMRI at the tasks and resting state. These results support the view that any single technique has its own advantages and limitations; and the integrations of multiple techniques, including diverse brain images and different paradigms, have the potential to improve predictive accuracy for DoC. Then, we provide methodological points of view and some prospects about future research. Totally, in comparison to a great many diagnostic methods for the DoC, the research of prognostic models is sparse and preliminary, still largely in its infancy with many challenges and opportunities. Keywords Disorders of consciousness · Prognostic model · Outcome · Conscious recovery · Prediction
Introduction Severe brain injury can lead to impaired consciousness. Some patients quickly recover consciousness from acute injuries, while some fall into the extending state of Ming Song and Yi Yang contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00018-020-03512-z) contains supplementary material, which is available to authorized users.
unawareness of self and environment. When such state has lasted for more than 28 days, the patient can be diagnosed as prolonged disorders of consciousness (DoC). The etiologies of DoC include trauma, stroke, anoxia and so on, thus it is a complex, heterogeneous and acquired condition. An estimated 100,000–300,000 patients with prolonged DoC are living in United States [1]. Prevalence figures in European vary from 0.2 to 6.1 patients per 100,000 members of the population [2]. No reliable nationwide data are available on the prevalence of DoC in China; but it is commonly thought
* Jianghong He [email protected]
4
Department of Neurosurgery, The 7th Medical Center of the PLA General Hosp
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