Elsevier

Pediatric Neurology

Volume 10, Issue 1, February 1994, Pages 27-33
Pediatric Neurology

Original article
Life expectancy of children in a persistent vegetative state

https://doi.org/10.1016/0887-8994(94)90063-9Get rights and content

Abstract

The persistent vegetative state (PVS) is a state of wakeful unconsciousness occurring in adults and children. Despite preservation of vegetative functions, PVS patients have a shortened life-span, although accurate information concerning this issue remains limited. The survival of children in PVS was examined to determine whether age, etiology of the vegetative state, or type of residence in which the patient lived affected the estimated survival. The data of 155,851 developmentally disabled California state residents were reviewed using the Client Development Evaluation Report (CDER). Criteria from the CDER were selected to define the vegetative state and included: lack of interaction with peers; absence of auditory, visual, and expressive or receptive language function; no hand or arm use; inability to eat, sit, roll over, or lift head; and no bowel or bladder control. There were 847 patients who met these criteria on the initial and follow-up CDERs. A product limit survival model was used to develop survival curves and to calculate the median survival time for patients grouped by age, etiology, and type of residence. Median survival (yrs) for patients who remained in PVS for the following age groups was: < 1 yr: 2.6, 1 < 2 yrs: 4.2, 2–6 yrs: 5.2, 7–18 yrs: 7.0, ≥ 19 yrs: 9.9. Median survival based on etiology varied from 3.0 to 8.6 years; no consistent relationship existed between etiology and duration of survival. Survival (yrs) for patients younger than age 18 years based on type of residence included: own home: 4.5, institutions: 5.2, skilled nursing facility/private hospital: 3.2, and other community care facilities: 3.7. Patients fed orally had a slightly longer median survival (5.5 yrs) than did patients in whom feeding tubes were used (4.9 yrs). Overall, the data indicated that long-term survival of PVS patients was markedly reduced.

References (22)

  • B Jennett et al.

    Persistent vegetative state after brain damage

    Lancet

    (1972)
  • WA Nelson et al.

    Decisions to withhold or terminate treatment

    Neurol Clin

    (1989)
  • RM Perkin et al.

    Pulmonary hypertension in pediatric patients

    J Pediatr

    (1984)
  • W Feinberg et al.

    A fate worse than death

    Am J Dis Child

    (1984)
  • American Medical Association Council on Scientific Affairs and Council on Ethical and Judicial Affairs

    Persistent vegetative state and the decision to withdraw or withhold life support

    JAMA

    (1990)
  • S Ashwal et al.

    The persistent vegetative state in children: Report of the Child Neurology Society Ethics Committee

    Ann Neurol

    (1992)
  • S Ashwal

    The persistent vegetative state in children

  • K Higashi et al.

    Five-year follow-up study of patients with persistent vegetative state

    J Neurol Neurosurg Psychiatry

    (1981)
  • RK Eyman et al.

    Survival of profoundly disabled people with severe mental retardation

    Am J Dis Child

    (1993)
  • RK Eyman et al.

    The life expectancy of profoundly handicapped people with mental retardation

    N Engl J Med

    (1990)
  • Cited by (42)

    • Gastrointestinal and nutritional problems in neurologically impaired children

      2016, European Journal of Paediatric Neurology
      Citation Excerpt :

      Common complications related to enteral nutrition in children may include constipation, vomiting or regurgitation, diarrhea, and excess weight gain. Moreover, minor catheter infections, perforation and an overall lessened length of survival have being described in both adult and pediatric population.35–40 The decision to start tube feeding is usually complex for families and carers of children and may be filled with decisional conflict.

    • Life expectancy of brain impaired, chronically ventilated children

      2013, Pediatric Neurology
      Citation Excerpt :

      Brain-damaged children were not mentioned in the list of etiologies, but they were possibly included under “others” (6%). The prognosis and life expectancy of children and young adults with minimal response have been extensively reviewed [3-6]. However, no report has been found on the prognosis and life expectancy of chronically ventilated children in minimally conscious state.

    • Nutrition and Feeding for Children with Developmental Disabilities

      2011, Pediatric Gastrointestinal and Liver Disease
    • Nutrition and Feeding for Children with Developmental Disabilities

      2010, Pediatric Gastrointestinal and Liver Disease
    • Nutrition and Feeding for Children with Developmental Disabilities

      2006, Pediatric Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management
    • Chronic disorders of consciousness

      2006, Lancet
      Citation Excerpt :

      Although a few patients with endstage neurodegenerative diseases, such as Alzheimer's, Huntington's, and Parkinson's, might reach minimally conscious state if they survive long enough,77 it is rare for them to progress to true vegetative state.78 Causes of vegetative state in children include trauma, meningitis, asphyxia, congenital malformations, and perinatal injuries.25,79 Children with anencephaly are arguably in a vegetative state, but children with less severe developmental disorders, such as hydranencephaly can show fragments of awareness behaviour when tested carefully.27

    View all citing articles on Scopus

    This study was supported in part by grants HD22953 and HD23056 from the National Institute of Child Health and Human Development.

    View full text