A Clinical Study on Patients in a Vegetative State after Severe Head Injury

ABSTRACT

A series of 41 patients in a vegetative state after severe head injury in presented. The patients selected were those who were in comatose state at least 2 weeks and observed more than 6 months. The vegetative state was more common before the age of 40(75.6%). The most common types of lesion causing vegetative state were subdural hematoma and epidural hematoma(56.1%). Twentyeight patients(68.1%) had a Glasgow coma score of 3 to 5. The two most frequent complications were urinary tract infections(80.5%) and bed sores(65.9%), but the most common cause of death was respiratory complication(60.0%). CT scans taken in the vegetative state showed variable evidences of cerebral atrophy, which were considered to be the results of the injury and had little value in predicting the outcome. At 6 months, the outcome was as follows good recovery 4(9.8%) ; moderate disability 7(17.1%) ; severe disability 12(29.3%) ; vegetative state 10(24.4%) ; and dead 8(19.5%). Twenty-three patients(56.1%) came out of the vegetative state during a 6 month follow-up period. Vegetative state is not always permanent. Therefore, it seems necessary to distinguish perisstent vegetative state from vegetative state. The term, "persistent", means that the patient, if ever, came out of the vegetative state and in the event he did he usually remained in severe disability. 15 out of the 23 improved within 2 months, 14 out of the 15 improved to at least moderate disability. 8 out of the 23 improved after 2 months but all remained in severe disability. From these results we propose that the term "persitent" be applied to patients who remain in a vegetative state for more than 2 months.