To describe the association between functional status and quality of life after coma from a neurological cause.

Coma is common after acute neurological catastrophes such as traumatic brain injury, ischemic stroke, intracerebral hemorrhage, hypoxic-ischemic brain injury from cardiac arrest, and seizures. Functional outcome and quality of life (QOL) are important considerations in coma recovery. The purpose of this study is to assess the association between these types of measures.

The Coma Cohort Study is an ongoing prospective observational study performed at an urban trauma center, stroke center, and safety net hospital. Coma was defined as a Glasgow Coma Scale ≤10, with no command following or intelligible speech for a minimum of 24 hours and not due to aphasia or sedation. Modified Rankin Scale (mRS), Glasgow Outcome Scale-Extended (GOSE), and EuroQoL (0=worst health you can imagine, 100=best health you can imagine) were collected at scheduled timepoints after injury. Spearman’s rho was used to assess correlations.

213 patients were enrolled over one year and 83 EuroQoL assessments were available. EuroQoL was significantly associated with mRS (rho=-.66, p<.001) and GOSE (rho=.64, p<.001). For patients with the highest disability on mRS, there was large variation in EuroQoL (mean=37.08, range=[0,80], IQR=26.25, SD=20.19). Within EuroQoL subscales, ability to do usual activities was most strongly associated with the overall rating (rho=.62, p<.001), followed by mobility (rho=.62, p<.001), washing and dressing (rho=.55, p<.001), and depression or anxiety (rho=.32, p=.005). There was large variation in EuroQoL for patients completely unable to do their usual activities (mean=42.59, range=[0,95] IQR=23.75, SD=22.22) and patients unable to walk (mean=39.76, range=[0,80], IQR=25, SD=21.12).

We found large variation in patient responses with many reporting good QOL despite significant disability. Using self- and surrogate-reported quality of life measures can obtain a more comprehensive assessment of patient status throughout recovery after coma from a neurological cause.