Research considerations for prospective studies of patients with coma and disorders of consciousness Article Swipe

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Lorenzo Tinti , Thomas Lawson , Erika Molteni , Daniel Kondziella , Verena Rass , Tarek Sharshar , Yelena G. Bodien , Joseph T. Giacino , Stephan A. Mayer , Moshgan Amiri , Susanne Muehlschlegel , Chethan P. Venkatasubba Rao , Paul Vespa , David Menon , Giuseppe Citerio , Raimund Helbok , Molly McNett , Sachin Agarwal , Venkatesh Aiyagari , Yama Akbari , Asher J. Albertson , Sheila Alexander , Anne W. Alexandrov , Ayham Alkhachroum , Fawaz Al‐Mufti , Moshagan Amiri , Brian Appavu , Meron Awraris Gebrewold , Marc Ayounb , Rafael Badenes , Mary Kay Bader , Neeraj Badjiata , Ram Balu , Brooke Barlow , Megan E. Barra , Rachel Beekman , Ettore Beghi , Erta Beqiri , Tracey Berlin , Federico Bilotta , Thomas P. Bleck , Yelena G. Bodien , Varina L. Boerwinkle , Mélanie Boly , Alexandra Bonnel , Luca Brazzi , Emery N. Brown , Sebina Bulic , Eder Cáceres , Adrian Cáceres , T Cafiero , Elizabeth Carroll , Emilio G. Cediel , Sherry Chou , Giuseppe Citerio , Jan Claassen , Chad Condie , Alfredo Conti , Katie Cosmas , Paolo Costa , Claire J. Creutzfeldt , Neha Dangayach , Mario Dauri , Derek Debicki , Michael DeGeorgia , Caroline Der‐Nigoghossian , Masoom Desai , Rajat Dhar , Michael N. Diringer , Emily Durr , Brian L. Edlow , Ari Ercole , Anna Estraneo , Guido J. Falcone , Salia Farrokh , Adam R. Ferguson , Davinia Fernández‐Espejo , Ericka L. Fink , Joseph J. Fins , Brandon Foreman , Federico Franchi , Jennifer Frontera , Rishi Ganesan , Nicolas Gaspard , Ahmeneh Ghavam , Joseph T. Giacino , Christie Gibbons , Emily J. Gilmore , Chavie Glustein , Olivia Gosseries , Theresa Green , David M. Greer , Mary Guanci , Deepak Gupta , Cecil D. Hahn , Ryan Hakimi , Flora Hammond , Daniel F. Hanley , Jed A. Hartings , Ahmed M. Hassan ·

YOU? · · 2023 · Open Access · · DOI: https://doi.org/10.1093/braincomms/fcae022

Disorders of consciousness are neurological conditions characterized by impaired arousal and awareness of self and environment. Behavioural responses are absent or are present but fluctuate. Disorders of consciousness are commonly encountered as a consequence of both acute and chronic brain injuries, yet reliable epidemiological estimates would require inclusive, operational definitions of the concept, as well as wider knowledge dissemination among involved professionals. Whereas several manifestations have been described, including coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state, a comprehensive neurobiological definition for disorders of consciousness is still lacking. The scientific literature is primarily observational, and studies-specific aetiologies lead to disorders of consciousness. Despite advances in these disease-related forms, there remains uncertainty about whether disorders of consciousness are a disease-agnostic unitary entity with a common mechanism, prognosis or treatment response paradigm. Our knowledge of disorders of consciousness has also been hampered by heterogeneity of study designs, variables, and outcomes, leading to results that are not comparable for evidence synthesis. The different backgrounds of professionals caring for patients with disorders of consciousness and the different goals at different stages of care could partly explain this variability. The Prospective Studies working group of the Neurocritical Care Society Curing Coma Campaign was established to create a platform for observational studies and future clinical trials on disorders of consciousness and coma across the continuum of care. In this narrative review, the author panel presents limitations of prior observational clinical research and outlines practical considerations for future investigations. A narrative review format was selected to ensure that the full breadth of study design considerations could be addressed and to facilitate a future consensus-based statement (e.g. via a modified Delphi) and series of recommendations. The panel convened weekly online meetings from October 2021 to December 2022. Research considerations addressed the nosographic status of disorders of consciousness, case ascertainment and verification, selection of dependent variables, choice of covariates and measurement and analysis of outcomes and covariates, aiming to promote more homogeneous designs and practices in future observational studies. The goal of this review is to inform a broad community of professionals with different backgrounds and clinical interests to address the methodological challenges imposed by the transition of care from acute to chronic stages and to streamline data gathering for patients with disorders of consciousness. A coordinated effort will be a key to allow reliable observational data synthesis and epidemiological estimates and ultimately inform condition-modifying clinical trials.

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Coma (optics) Persistent vegetative state Consciousness Medicine Prospective cohort study Psychology Psychoanalysis Intensive care medicine Psychiatry Internal medicine Minimally conscious state Neuroscience Physics Astronomy

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Language: en
Landing Page: https://doi.org/10.1093/braincomms/fcae022
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Title: Research considerations for prospective studies of patients with coma and disorders of consciousness

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Publication year: 2023

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Authors: Lorenzo Tinti, Thomas Lawson, Erika Molteni, Daniel Kondziella, Verena Rass, Tarek Sharshar, Yelena G. Bodien, Joseph T. Giacino, Stephan A. Mayer, Moshgan Amiri, Susanne Muehlschlegel, Chethan P. Venkatasubba Rao, Paul Vespa, David Menon, Giuseppe Citerio, Raimund Helbok, Molly McNett, Sachin Agarwal, Venkatesh Aiyagari, Yama Akbari, Asher J. Albertson, Sheila Alexander, Anne W. Alexandrov, Ayham Alkhachroum, Fawaz Al‐Mufti, Moshagan Amiri, Brian Appavu, Meron Awraris Gebrewold, Marc Ayounb, Rafael Badenes, Mary Kay Bader, Neeraj Badjiata, Ram Balu, Brooke Barlow, Megan E. Barra, Rachel Beekman, Ettore Beghi, Erta Beqiri, Tracey Berlin, Federico Bilotta, Thomas P. Bleck, Yelena G. Bodien, Varina L. Boerwinkle, Mélanie Boly, Alexandra Bonnel, Luca Brazzi, Emery N. Brown, Sebina Bulic, Eder Cáceres, Adrian Cáceres, T Cafiero, Elizabeth Carroll, Emilio G. Cediel, Sherry Chou, Giuseppe Citerio, Jan Claassen, Chad Condie, Alfredo Conti, Katie Cosmas, Paolo Costa, Claire J. Creutzfeldt, Neha Dangayach, Mario Dauri, Derek Debicki, Michael DeGeorgia, Caroline Der‐Nigoghossian, Masoom Desai, Rajat Dhar, Michael N. Diringer, Emily Durr, Brian L. Edlow, Ari Ercole, Anna Estraneo, Guido J. Falcone, Salia Farrokh, Adam R. Ferguson, Davinia Fernández‐Espejo, Ericka L. Fink, Joseph J. Fins, Brandon Foreman, Federico Franchi, Jennifer Frontera, Rishi Ganesan, Nicolas Gaspard, Ahmeneh Ghavam, Joseph T. Giacino, Christie Gibbons, Emily J. Gilmore, Chavie Glustein, Olivia Gosseries, Theresa Green, David M. Greer, Mary Guanci, Deepak Gupta, Cecil D. Hahn, Ryan Hakimi, Flora Hammond, Daniel F. Hanley, Jed A. Hartings, Ahmed M. Hassan

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Concepts: Coma (optics), Persistent vegetative state, Consciousness, Medicine, Prospective cohort study, Psychology, Psychoanalysis, Intensive care medicine, Psychiatry, Internal medicine, Minimally conscious state, Neuroscience, Physics, Astronomy

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