Prognosis of the posttraumatic vegetative state

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Abstract
Of 1373 patients who, following severe brain injury had been comatose for over 6 hours, 140 (10%) were in a vegetative state one month later. Fifty-nine regained consciousness but none of those aged over 40 became independent during the first year. Of those still in a vegetative state after 3 months, none became independent irrespective of age. Of all patients comatose for over 6 hours after severe brain injury, only 1% was in a vegetative state after one year. Certain scores for features such as age, pupillary reactions, eyeopening and eye movements indicate either a favourable prognosis, a fatal outcome or irreversible coma. It is only in some 10% of all patients in coma or in a vegetative state during the first two weeks after the accident that it is possible to predict with a high degree of probability (p > 0.95), an unfavourable outcome (death or irreversible coma) within one year. At no time after the onset of coma is it possible to predict or distinguish, with a fair degree of probability (e.g. p > 0.80), those patients who will remain in a vegetative state from those who will die.

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