Consciousness trajectories and functional independence after acute brain injury in children with prolonged disorder of consciousness

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AIM: To explore the trajectories of consciousness recovery and prognosis-associated predictors in children with prolonged disorder of consciousness (pDoC). METHOD: This single-centre, retrospective, observational cohort involved 134 (87 males, 47 females) children diagnosed with pDoC and hospitalized at the Department of Rehabilitation at the Children's Hospital of Chongqing Medical University in China. The median onset age was 30 (interquartile range [IQR] 18-54) months, with onset ages ranging from 3 to 164 months. Least absolute shrinkage and selection operator (LASSO) regression and logistic regression analyses were performed to identify the independent predictors of consciousness recovery at 1 year after brain injury. Discrimination and calibration were assessed using 1000 bootstrap resamples. The potential predictors of resultant living independence were also explored. RESULTS: The predictors for consciousness recovery at 1-year postinjury were: traumatic brain injury (odds ratio [OR]: 3.26, 95% confidence interval [95% CI]: 1.21-9.46), age at brain injury onset ≥ 3 years old (OR: 2.60, 95% CI: 1.03-6.82), electroencephalogram (EEG) grade IV or below based on Young's classification (OR: 3.41, 95% CI: 1.38-8.70), and no bilateral impairments in the basal ganglia (OR: 3.75, 95% CI: 1.50-9.91) or posterior cingulate (OR: 5.61, 95% CI: 2.20-15.54). A nomogram was constructed with the area under the curve of 0.845 (95% CI: 0.780-0.911). Additionally, EEG grade IV or below, and the absence of bilateral impairments in the frontal lobes and occipital lobes were associated with favorable functional outcomes. INTERPRETATION: These findings underscore the importance of comprehensive early-stage assessments in evaluating consciousness and function, assisting clinicians and families in making clinical decisions.

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