Emergence to the Conscious State During Inpatient Rehabilitation After Traumatic Brain Injury in Children and Young Adults: A Case Series

Objective: To describe clinical patterns related to emergence to the conscious state (CS) in children and young adults with traumatic brain injury receiving acute inpatient rehabilitation. Setting: One academically affiliated pediatric brain injury rehabilitation unit. Participants: Fourteen consecutive patients aged 1 to 20 years with traumatic brain injury and disorders of consciousness. Design: Retrospective case series. Main Measures: The primary outcome was emergence to CS during the inpatient rehabilitation admission. Factors evaluated for relationship to emergence to CS included age at injury, admission level of consciousness, admission Rappaport Coma/Near-Coma Scale score, and admission Cognitive and Linguistic Scale responsiveness item score. Results: Ten of 14 patients emerged to CS during the inpatient rehabilitation admission. Those who emerged to CS had higher levels of responsiveness at admission to rehabilitation. There was a trend toward older age in those who emerged to CS. Conclusions: In this limited cohort, the majority of patients with disorders of consciousness after traumatic brain injury emerged to CS during acute inpatient rehabilitation, underscoring the presence of functional goals for inpatient rehabilitation in this population. Larger cohorts are needed to further explore clinical variables associated with emergence to CS.