178 Views

1128 - Identifying Patterns of Cognitive Recovery in Pediatric Disorder of Consciousness Upon Completion of Acute Inpatient Rehabilitation

Friday, February 28, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

RS

Rekha P. Swamy, BA

Medical Student
University of Missouri at Kansas City
Kansas City, Missouri, United States

Co-Author(s)

KN

Kian Nassiri, DO

Brain Injury Attending Physician
Shirley Ryan AbilityLab
Chicago, Illinois, United States
EK

Emily J. Kivlehan, MD

MD Attending Physician
Shirley Ryan AbilityLab
Chicago, Illinois, United States

Objectives: Pediatric disorder of consciousness (DOC) is an understudied topic in rehabilitation literature. This study aims to address this gap by describing the prevalence of each state of consciousness in the pediatric DOC population and identifying patterns of recovery of consciousness, including rates of emergence in patients undergoing acute inpatient rehabilitation (AIR).

Design: We performed a retrospective study on pediatric patients (ages 4-18) admitted to AIR facility in a DOC due to traumatic (TBI)/non-traumatic (nTBI) brain injuries over a 10-year period (2014-2024). After classifying patients based on TBI and nTBI etiologies, initial and final coma recovery scale–revised (CRS-R) scores were recorded and used to assign the state of consciousness: unresponsive wakefulness syndrome (UWS), minimally conscious states plus (MCS+) and minus (MCS-), or emergence (eMCS) at admission and discharge. Percentages were used for comparison to identify patients who improved, remained the same, or declined in their level of consciousness.

Results: 59 patients were included in the sample, 44 TBI (74.6%) and 15 nTBI (25.4%). Admit state of consciousness TBI subgroup: 20 UWS (33.9%), 14 MCS- (23.7%), and 10 MCS+ (16.9%); Discharge state of consciousness TBI subgroup: 8 UWS (13.6%), 6 MCS- (10.2%), 16 MCS+ (27.1%), and 14 eMCS (23.7%). Admit state of consciousness nTBI subgroup: 10 UWS (16.9%), 1 MCS- (1.7%), and 4 MCS+ (6.8%). Discharge state of consciousness: 5 UWS (8.5%), 2 MCS- (3.4%), 7 MCS+ (11.9%), and 1 eMCS (1.7%). Rates of emergence from DOC of TBI and nTBI were 24% and 2%, respectively. Documented improvement in cognitive status in TBI and nTBI subgroups were 49% and 10% respectively.

Conclusions: Our study found that pediatric patients with a DOC have documented improvement in cognitive status after undergoing AIR, demonstrating it may be a beneficial intervention for this population. Further research is needed to compare the outcomes of patients undergoing AIR versus those not.