Research Needs for Prognostic Modeling and Trajectory Analysis in Patients with Disorders of Consciousness

Flora M Hammond^{1

2}, Sheryl Katta-Charles^{3

4}, Mary Beth Russell^{5

6}, Ross D Zafonte^{7

8

9

10}, Jan Claassen^{11

12}, Amy K Wagner¹³, Louis Puybasset^{14

15}, Satoshi Egawa¹⁶, Steven Laureys^{17

18}, Michael Diringer¹⁹, Robert D Stevens²⁰; Curing Coma Campaign and its Contributing Members

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, 4141 Shore Drive, Indianapolis, IN, 46254, USA. Flora.hammond@rhin.com.
² Rehabilitation Hospital of Indiana, Indianapolis, IN, USA. Flora.hammond@rhin.com.
³ Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, 4141 Shore Drive, Indianapolis, IN, 46254, USA.
⁴ Rehabilitation Hospital of Indiana, Indianapolis, IN, USA.
⁵ Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
⁶ TIRR Memorial Hermann, Houston, TX, USA.
⁷ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Harvard University, 300 First Avenue, Boston, MA, 02129, USA.
⁸ Spaulding Rehabilitation Hospital, Boston, MA, USA.
⁹ Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Brigham and Women's Hospital, Boston, MA, USA.
¹¹ Department of Neurology, NewYork-Presbyterian Hospital, New York City, NY, USA.
¹² Columbia University, New York City, NY, USA.
¹³ Department of Physical Medicine and Rehabilitation and Neuroscience, Clinical and Translational Science Institute, Safar Center for Resuscitation Research, and Center for Neuroscience, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
¹⁴ Department of Anesthesiology and Intensive Care, Sorbonne University, Paris, France.
¹⁵ Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁶ Neurointensive Care Unit, Department of Neurosurgery, and Stroke and Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan.
¹⁷ Coma Science Group, University Hospital of Liege, Liege, Belgium.
¹⁸ International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.
¹⁹ Departments of Neurology, Neurosurgery, and Anesthesiology, Washington University School of Medicine, St Louis, MO, USA.
²⁰ Division of Neuroscience Critical Care, Departments of Anesthesiology and Critical Care Medicine and Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PMID: 34236623
PMCID: PMC8848858
DOI: 10.1007/s12028-021-01289-y

Research Needs for Prognostic Modeling and Trajectory Analysis in Patients with Disorders of Consciousness

Flora M Hammond et al. Neurocrit Care. 2021 Jul.

. 2021 Jul;35(Suppl 1):55-67.

doi: 10.1007/s12028-021-01289-y. Epub 2021 Jul 8.

Authors

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, 4141 Shore Drive, Indianapolis, IN, 46254, USA. Flora.hammond@rhin.com.
² Rehabilitation Hospital of Indiana, Indianapolis, IN, USA. Flora.hammond@rhin.com.
³ Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, 4141 Shore Drive, Indianapolis, IN, 46254, USA.
⁴ Rehabilitation Hospital of Indiana, Indianapolis, IN, USA.
⁵ Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
⁶ TIRR Memorial Hermann, Houston, TX, USA.
⁷ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Harvard University, 300 First Avenue, Boston, MA, 02129, USA.
⁸ Spaulding Rehabilitation Hospital, Boston, MA, USA.
⁹ Massachusetts General Hospital, Boston, MA, USA.
¹⁰ Brigham and Women's Hospital, Boston, MA, USA.
¹¹ Department of Neurology, NewYork-Presbyterian Hospital, New York City, NY, USA.
¹² Columbia University, New York City, NY, USA.
¹³ Department of Physical Medicine and Rehabilitation and Neuroscience, Clinical and Translational Science Institute, Safar Center for Resuscitation Research, and Center for Neuroscience, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
¹⁴ Department of Anesthesiology and Intensive Care, Sorbonne University, Paris, France.
¹⁵ Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
¹⁶ Neurointensive Care Unit, Department of Neurosurgery, and Stroke and Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan.
¹⁷ Coma Science Group, University Hospital of Liege, Liege, Belgium.
¹⁸ International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.
¹⁹ Departments of Neurology, Neurosurgery, and Anesthesiology, Washington University School of Medicine, St Louis, MO, USA.
²⁰ Division of Neuroscience Critical Care, Departments of Anesthesiology and Critical Care Medicine and Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PMID: 34236623
PMCID: PMC8848858
DOI: 10.1007/s12028-021-01289-y

Abstract

Background: The current state of the science regarding the care and prognosis of patients with disorders of consciousness is limited. Scientific advances are needed to improve the accuracy, relevance, and approach to prognostication, thereby providing the foundation to develop meaningful and effective interventions.

Methods: To address this need, an interdisciplinary expert panel was created as part of the Coma Science Working Group of the Neurocritical Care Society Curing Coma Campaign.

Results: The panel performed a gap analysis which identified seven research needs for prognostic modeling and trajectory analysis ("recovery science") in patients with disorders of consciousness: (1) to define the variables that predict outcomes; (2) to define meaningful intermediate outcomes at specific time points for different endotypes; (3) to describe recovery trajectories in the absence of limitations to care; (4) to harness big data and develop analytic methods to prognosticate more accurately; (5) to identify key elements and processes for communicating prognostic uncertainty over time; (6) to identify health care delivery models that facilitate recovery and recovery science; and (7) to advocate for changes in the health care delivery system needed to advance recovery science and implement already-known best practices.

Conclusion: This report summarizes the current research available to inform the proposed research needs, articulates key elements within each area, and discusses the goals and advances in recovery science and care anticipated by successfully addressing these needs.

Keywords: Algorithms; Brain injuries; Coma; Disorders of consciousness; Function; Outcome; Prognosis; Recovery; Recovery science; Research; Statistical models; Trajectories.

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Figures

**Fig. 1**
At the 2-year follow-up, endotype 2 appears markedly different from endotype 3 and appears to have declined from the 1-year follow-up. However, by the 5-year follow-up, endotype 2 progresses past endotype 3. At the present time, variables for identifying markers to assign a patient to a particular endotype are lacking. In addition, the common trajectories and meaningful markers (y axis) are not adequately identified

**Fig. 2**
Key objectives to be addressed in an ideal health care delivery model that integrates research and prognostication

See this image and copyright information in PMC

References

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1. Whyte J, Nakase-Richardson R, Hammond FM, McNamee S, Giacino JT, Kalmar K, et al. Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems. Arch Phys Med Rehabil. 2013;94(10):1855–60. - PubMed
1. Hammond FM, Giacino JT, Nakase Richardson R,Sherer M, Zafonte RD, Whyte J, et al. Disorders of consciousness due to traumatic brain injury: functional status ten years post-injury. J Neurotrauma. 2019;36(7):1136–46. - PubMed

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Research Needs for Prognostic Modeling and Trajectory Analysis in Patients with Disorders of Consciousness

Affiliations

Research Needs for Prognostic Modeling and Trajectory Analysis in Patients with Disorders of Consciousness

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous