Disorders of Consciousness in Acute Care: Application of the CRS-R and Respiratory, Swallowing, and Discharge Outcomes at a Level 1 Trauma Hospital.
Sara Penrod, Zoe Samson, Stephanie C Chan
PMID 42769657WHAT IT FOUND
In 68 adults with severe disorders of consciousness, consciousness improved by discharge.
Many tolerated speaking-valve and capping trials, and swallowing progressed from no oral intake, but this was descriptive.
Key findings
01Initial assessments categorized 52.9% as unresponsive wakefulness and 2.9% as coma; by discharge, no patient remained in coma and 41.2% had emerged from minimally conscious state.
02Tracheostomy was performed in 73.5% of patients; among them, 88% completed speaking-valve trials, 72% capping trials, and 68% were decannulated.
03All patients had no oral intake on admission; at discharge, 47.1% remained at Functional Oral Intake Scale level 1, and the rest showed some oral intake progress.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This was a single-center retrospective cohort, so the results may not apply to other hospitals. There was no comparison group, so the study cannot show that any treatment caused the observed progress. The sample was small, and case identification may have missed eligible patients. The study did not assess the efficacy or safety of specific swallowing or tracheostomy interventions. Patients received physical therapy, occupational therapy, and speech-language pathology services at variable frequencies, and the study did not analyze individual treatment plans. Coma Recovery Scale-Revised results can be affected by motor impairment, spasticity, pain, agitation, medication effects, or other confounders. Complications such as hydrocephalus, subdural hematoma, infection, dysautonomia, lesion location, and neurostimulant use were not tracked. Objective measures of covert consciousness were not used. Longer-term outcomes after discharge were not examined. Prolonged acute care stays, partly due to barriers to postacute placement, may have influenced recovery and decannulation rates.
Declared interests
The investigators reported no financial or nonfinancial disclosures.