{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T09:00:31Z","timestamp":1790413231488,"version":"4.1.0"},"reference-count":55,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:00:00Z","timestamp":1790380800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Management of lasting disorders of consciousness (DoC) is complex and sometimes requires referral of patients to an expert team. We aimed to evaluate the impact of such specialized expert assessment through the description of a single\u2010center experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Monocentric study including all patients with DoC referred to a tertiary neuroICU for multimodal clinical, electrophysiological, and MRI assessment allowing diagnostic and therapeutic proposals and multidisciplinary prognostic prediction. The primary endpoint was the patients' actual outcome, assessed by 3\u2010month functional disability and 1\u2010year mortality, according to the predicted prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between July 2017 to June 2024, 124 patients (median age 61 [49\u201370] years, 67% of men) were referred from 43 departments of 37 primary hospitals. Most frequent etiologies were post\u2010anoxic encephalopathy (62%) and secondary systemic brain injuries (15%). At a median of 23 [15\u201333] days after DoC onset, predicted prognosis was good in 20 (16%) patients, intermediate in 41 (33%), and poor in 63 (51%). Three\u2010month GOS\u2010E was 3 [1\u20133], 2 [1\u20133], and 1 [1] (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and 1\u2010year mortality was 30%, 41%, and 82% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), respectively. Withdrawal of life\u2010sustaining therapies increased with worsening predicted prognosis (38%, 41%, and 65%, respectively,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), but functional disability and mortality remained higher in the poor prognosis group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.003 and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.039, respectively) even after excluding patients with those decisions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Specialized consciousness assessment impacts the ethical decisions made by primary centers and helps refine the prediction of recovery but fails to achieve highly accurate individual prediction in a population with overall poor survival and functional prognosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70536","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T08:45:52Z","timestamp":1790412352000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of a Specialized Care Pathway for\n                    <scp>ICU<\/scp>\n                    Patients With Disorders of Consciousness: Observational Insights From an Expert Center"],"prefix":"10.1111","volume":"33","author":[{"given":"Cl\u00e9ment","family":"Caiazzo","sequence":"first","affiliation":[{"name":"Neurointensive Care Department GHU\u2010Paris Psychiatrie et Neurosciences, H\u00f4pital Sainte\u2010Anne  Paris 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