Persistent vegetative state and minimally conscious state units in France, current situation 10 years after their creation
Mr Joffrey DRIGNYa, Dr Catherine KIEFERb, Dr Béatrice ALBINET-FOURNOTc, Dr Alexis RUETa, Dr James CHARANTONd, Prof Pascale PRADAT-DIEHLd
a Service de Médecine Physique et de Réadaptation, CHU Caen, France, b Service de Médecine Physique et de Réadaptation, Hopital Nord 92, Villeneuve-la-Garenne, France, c Service SSR EVC/EPR, Korian Canal de L'Ourcq, Villeneuve-la-Garenne, France, d Centre Ressources Francilien du Traumatisme Crânien, Paris
Introduction: Since May 2002, hospital care for Persistent Vegetative State (PVS) or Minimally Conscious State (MCS) patients in France are structured in dedicated units: PVS/MCS units. The aim of this survey is to analyze the current situation after 10 years.
Method: In 2012, the 135 health institutions with PVS/MCS units were contacted to fill out a questionnaire with information about health facilities, human resources, patients care pathways and characteristics.
Results: Fifty one institutions (38%) answered the questionnaire. The PVS/MCS units had an average of 8.3 authorized beds (max-min, 4-19), for 8.1 available beds and a 97% bed occupation rate. They admitted on average 21 patients since their creation. Important disparities regarding staff ressources existed between these Units. With regard to the 348 patients documented (mean age 48.2, min 13 max 82), 36% were in PVS ans, 51% were in MCS, 10% had left MCS. Arousal state improved since admission for 25% and decreased for 1%. Initial pathology was traumatic brain injury for 35%, anoxic brain injury for 27%, stroke for 22%. Initially, 70% of the patients had quadriplegia, and 30% had hemiplegia, 88% of them had orthopedic complications. Among the patients, 45% had a tracheotomy and 92% had a digestive stomy. Mean length of stay was 4.5 years. The annual mortality rate was below 5%. Finally 12% awaited another living unit because their state of consciousness had improved.
Discussion/Conclusion: Structured hospital care for Persistent Vegetative State (PVS) patients or Minimally Conscious State (MCS) in France appears adequate to meet the quality objectives fixed by the May 3rd, 2012 commission regarding health facilities, admission criteria and health care. Patients require important care and staff ressources. Patient discharge from these units is frequently a problem in case of improvement because of a lack of adequate living places.
Keywords : Disorders of consciousness, Health-care facilities, human ressources