Clinical Prognosis

The ability to predict outcome for individuals in the persistent vegetative state is important for the generation of a reasonable care plan for the patient. Several variables play a role in the prognosis of patients in the persistent vegetative state. One factor that may influence outcome is the etiology of the persistent vegetative state. For example, subarachnoid hemorrhage can have the worst prospects for recovery, whereas insults resulting from hypoxia-ischemia and metabolic causes may have a better outcome.

Duration of coma and the persistent vegetative state following a hypoxic-ischemic event can also influence outcome. Although some case reports document recovery following prolonged periods in the persistent vegetative state, patients can suffer permanent neurologic sequelae if coma duration is at least 6 hr. Most individuals in the persistent vegetative state for a duration of 1 month following a hypoxic-ischemic insult do not recover.

In survivors of cardiac arrest who become vegetative, the prognosis for recovery is not significantly correlated with age. Younger patients may demonstrate improved ability to recover motor function. However, age is not a factor in the recovery of cognition, behavior, or speech.

Prediction of outcome for traumatic-induced persistent vegetative state usually parallels the criteria used for persistent vegetative state unrelated to trauma. Persistent vegetative state of prolonged duration rarely results in recovery of independent function but does occasionally occur. Features such as young age (less than 40 years old), pupillary reactivity, and eye opening signify a favorable prognosis for individuals in the persistent vegetative state following trauma.

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