Disclosures: Jean E. Woo, MD: No financial relationships or conflicts of interest
Objective: To investigate rate of admission following a referral and outcomes after DoC rehabilitation
Design: A single-institution retrospective chart review Setting : Inpatient rehabilitation Participants : Brain injury patients who were referred to DoC rehabilitation program in 2018
Interventions: Not applicable
Main Outcome Measures: Admission rate; reasons for denied admissions; level of consciousness at discharge
Results: Half of the referrals (53/100) were denied mainly due to financial barriers (43.4%) and medical instability (24.5%). A total of 32 new patients were admitted for DoC rehabilitation. 28.1% (9/32) patients were found fully conscious on multidisciplinary evaluation within 2-3 days (Group I, likely misdiagnosed); 37.5% (12/32) patients were considered minimally conscious state (Group II, MCS); 34.4% (11/32) patients were considered unresponsive wakefulness syndrome/vegetative state (Group III, UWS/VS). Patients in Group I demonstrated either functional communication or functional object use within 3.3±1.8 days after admission. In Group II, 83.3% (10/12) patients emerged by discharge. In Group III, no one emerged, but 72.7% (8/11) improved to MCS by discharge. Among presumably “true” DoC patients on admission, 43.5% (10/23) emerged, 43.5% (10/23) were MCS, 13% (3/23) remained UWS/VS after the first round of DoC rehabilitation. Among the patients who emerged, 63.2% (12/19) were found to have emerged within 1 week, 89.5% (17/19) within 1 month, and 100% (19/19) within 3 months after admission. Conclusions: If DoC rehabilitation was denied because of futility of it, at least 60% (19/32) of the patients who were labelled as DoC would have lost the opportunity to re-connect to the world and their families. MCS and UWS/VS patients have a high likelihood for future emergence and regaining consciousness, respectively. The DoC specialists could quickly identify the potentially “misdiagnosed” patients and assist with advancement of the level of consciousness. Even when the patients only improved to or remained MCS, the proven consciousness opened up opportunities for continued rehabilitation and recovery.
Level of Evidence: Level IV
To cite this abstract in AMA style:
Woo JE, Zhang B, O'Brien K. What Happens to the Small Number of Referrals That Make It to a Disorders of Consciousness (DoC) Rehabilitation Program [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/what-happens-to-the-small-number-of-referrals-that-make-it-to-a-disorders-of-consciousness-doc-rehabilitation-program/. Accessed May 16, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/what-happens-to-the-small-number-of-referrals-that-make-it-to-a-disorders-of-consciousness-doc-rehabilitation-program/