One ballmark of severe traumatic brain injury (TBI) is a loss of consciousness followed by varying states of consciousness. Estimates suggest that 30–40% of individuals who survive severe TBI will stay in low-level or reduced states of consciousness for prolonged periods. The state of coma is relatively easy to diagnose; however, differential diagnosis of other states of reduced consciousness have proven to be much more difficult, precipitating a number of problems related to prognosis, treatment, and rehabilitation. Accurate diagnosis is critical in determining the prognosis for persons with severe TBI because it has significant implications for the patient, family, clinician, and payer. Studies have shown that prognosis directly influences numbers and types of treatments recommended. Often, families find themselves being forced to make critical decisions with little knowledge and a great deal of uncertainty. Understanding reduced states of consciousness and facilitating accurate evaluation of such states allow neuroscience nurses to help families effectively cope during this difficult time.
Questions or comments about this article may be directed to: Roxanne Pickett Hauber, PhD RN CNRN, at the TeleRehabilitation Program, Shepherd Center, 2020 Peachtree Road NW, Atlanta, GA 30309. She is a nurse researcher and manager at the TeleRehabilitation Program, Shepherd Center.
Linda Testani-Dufour, MSN RN CRRN, is a clinical nurse specialist at the Acquired Brain Injury Program, Shepherd Center.
© 2000 American Association of Neuroscience Nurses