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

  • THE CURING COMA CAMPAIGN
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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.

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Acknowledgements

The authors wish to acknowledge the Curing Coma Campaign collaborators participating in the overall program, as listed in Supplementary Table 1.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, 4141 Shore Drive, Indianapolis, IN, 46254, USA

    Flora M. Hammond & Sheryl Katta-Charles

  2. Rehabilitation Hospital of Indiana, Indianapolis, IN, USA

    Flora M. Hammond & Sheryl Katta-Charles

  3. Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA

    Mary Beth Russell

  4. TIRR Memorial Hermann, Houston, TX, USA

    Mary Beth Russell

  5. Department of Physical Medicine and Rehabilitation, Harvard Medical School, Harvard University, 300 First Avenue, Boston, MA, 02129, USA

    Ross D. Zafonte

  6. Spaulding Rehabilitation Hospital, Boston, MA, USA

    Ross D. Zafonte

  7. Massachusetts General Hospital, Boston, MA, USA

    Ross D. Zafonte

  8. Brigham and Women’s Hospital, Boston, MA, USA

    Ross D. Zafonte

  9. Department of Neurology, NewYork-Presbyterian Hospital, New York City, NY, USA

    Jan Claassen

  10. Columbia University, New York City, NY, USA

    Jan Claassen

  11. 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

    Amy K. Wagner

  12. Department of Anesthesiology and Intensive Care, Sorbonne University, Paris, France

    Louis Puybasset

  13. Groupe Hospitalier Pitié–Salpêtrière, Assistance Publique–Hôpitaux de Paris, Paris, France

    Louis Puybasset

  14. Neurointensive Care Unit, Department of Neurosurgery, and Stroke and Epilepsy Center, TMG Asaka Medical Center, Saitama, Japan

    Satoshi Egawa

  15. Coma Science Group, University Hospital of Liege, Liege, Belgium

    Steven Laureys

  16. International Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China

    Steven Laureys

  17. Departments of Neurology, Neurosurgery, and Anesthesiology, Washington University School of Medicine, St Louis, MO, USA

    Michael Diringer

  18. 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

    Robert D. Stevens

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  1. Flora M. Hammond
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  5. Jan Claassen
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  8. Satoshi Egawa
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the Curing Coma Campaign and its Contributing Members

Contributions

All authorship requirements have been met and the final manuscript was approved by all authors.

Corresponding author

Correspondence to Flora M. Hammond.

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Conflict of interest

The authors do not possess any relevant conflicts of interest to disclose. Dr. Hammond reports grants from NIDILRR, personal fees from Avanir, personal fees from Lash Publishing, Inc, personal fees from Demos Publishing, outside the submitted work. Drs. Katta-Charles, Wagner, Egawa, Laureys, and Diringer have nothing to disclose. Dr. Russell reports personal fees from Merz, personal fees from Allergan, outside the submitted work. Dr. Zafonte reports past royalties from (1) Oakstone for an educational CD- Physical Medicine and Rehabilitation a Comprehensive Review; (2) Springer/Demos publishing for serving as co- editor of the text Brain Injury Medicine. Dr Zafonte serves on or previously served on the Scientific Advisory Board of Myomo, Oxeia Biopharma, ElMINDA and Biodirection. Dr. Claassen reports grants from NINDS R01 NS106014 , grants from McDonnell Foundation, grants from NINDS R03 NS112760, other from iCE Neurosystems, outside the submitted work. Dr. Puybasset reports grants from EU- CenterTBI, grants from French ANR, during the conduct of the study; personal fees from BRAINTALE, outside the submitted work; In addition, Dr. Puybasset has a patent WO2012160316 issued. Dr. Stevens reports other from Edwards Lifesciences outside the submitted work.

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The Curing Coma Campaign is supported by the Neurocritical Care Society.

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Hammond, F.M., Katta-Charles, S., Russell, M.B. et al. Research Needs for Prognostic Modeling and Trajectory Analysis in Patients with Disorders of Consciousness. Neurocrit Care 35 (Suppl 1), 55–67 (2021). https://doi.org/10.1007/s12028-021-01289-y

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