@2024 Afarand., IRAN

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ISSN: 1027-1457    Scientific Journal of Forensic Medicine 2019;25(4):185-188

Background
The survival rate of patients with vegetative state depends on many factors such as the amount of medical equipment used and how they are cared.
Previous Studies
When the brain is suppressed by hypoxia, trauma, or poisoning but the brainstem is working, the person loses consciousness and ability to communicate to the environment; however, the heart and respiratory system are still working. Such person has a vegetative state. These deaths are usually caused by complications, such as skin necrosis or secondary infections [1]. In fact, the persistent vegetative state is a state of consciousness, in which the individual has no cognitive relationship with the outside world and despite the fact that his eyes are sometimes open, he does not have a purposeful look at his surroundings and is not capable of making contact and being aware of the surroundings. This condition is also called apalic syndrome or unresponsive wakefulness syndrome [2]. Patients in the vegetative state do not have motor behavior in response to commands and are therefore considered to be unaware of themselves and the environment [3]. … [4-7].
Aim(s)
The purpose of this study was to investigate the survival rate of patients with vegetative state referred to forensic medicine centers in Tehran from the beginning of 2008 to the end of 2017.
Research type
This research was a retrospective descriptive cross-sectional study.
Research society, place and time
In this study, 58 records of patients with vegetative state referred to forensic medical centers in Tehran during 10 years (beginning of 2008 to the end of 2017) were studied.
Sampling method and number

Used devices&materials
Necessary information, including sex, age, survival after vegetative status, cause of vegetative status, and cause of death were extracted from the files. The extracted information from documents was analyzed using SPSS 23 software and chi-square test.
Findings by Text
58 cases were finally reviewed out of all cases who had referred to forensic medical examinations due to vegetative state during 10 years (from the beginning of 2008 to the end of 2017) and had been followed up and had complete records, of whom 31 cases (53.4%) were still alive at the time of the study and 27 cases (46.6%) had died. The mean age of the subjects was 74.52 ± 6.17 years, ranging from 18 to 90 years. The youngest and oldest men aged 24 and 77 years and 18 and 90 years for women. Of 58 people with vegetative state, 40 cases (69.0%) were male and 18 cases (31.0%) were female and according to the time of the study, 16 cases (59.3%) were male and 11 cases (40.7%) were female and of those who were still alive at the end of 2017, 24 cases (77.4%) were male and 7 cases (22.6%) were female. The mean life span after vegetative state was 6.39 ± 1.50 months. At the end of 2017, in a total of 58 studied subjects, the minimum survival time after vegetative state was 2 months and the maximum was 192 months (16 years) at the time of study. The mean survival time of 90% of cases in the middle of the study (excluding 5% of those with minimum survival and 5% with maximum survival after vegetative state) was 3.12 ± 1.34 months, which was 3.32 ± 2.03 months for men and 1.38 ± 1.52 months for women. Of the 58 people with vegetable state, the following causes were obtained: 32 cases (55.2%): multiple bodily injuries (car accident, falling from height), 12 cases (20.7%): unknown causes, 4 cases (6.9%): stroke, 3 cases (5.2%): Post CPR, 3 cases (5.2%): brain tumor, 2 cases (3.4%): electrocution, one case (1.7%): encephalitis, and one person (1.7%): drug poisoning. In people whose vegetable state led to death, the causes of death were as follows: 12 cases (44.4%): multifactorial failure, 7 cases (25.9%): septic shock, 5 cases (18.5%): acute myocardial infarction, 2 cases (7.4%): acute renal failure, and one case (3.7%): acute stroke. There was no statistically significant relationship between survival of cases with vegetative state and sex (p = 0.33) and age (p = 0.34). Also, there was no statistically significant relationship between the cause of vegetative state and the survival of these cases (p = 0.93).
Main comparison to the similar studies
... [8, 9]. In a study conducted in California on 1,021 patients with vegetative state from 1981 to 1996, mortality risk factors included gastrostomy and ventilator dependence [10]. Another study conducted in California on 705 children aged 3 and 15 years with vegetative state from 1988 to 1997 reported that 63% of the cases survived only for eight years [11]. Another study was conducted on 847 cases with vegetative state in California and it was found that the average survival of individuals (etiologically) ranged from 3 to 6.8 years [12]. Therefore, the results of our study also showed a similar survival rate (about 3 years), which is consistent with the results of these studies. … [13, 14].
Suggestions
It is recommended to use this study in future studies as the basis for examining the number of atonements lost in this group of individuals regarding their survival after vegetative state their care costs.
Limitations
One of the limitations of this study was the deficiencies in the files, including the duration of survival after experiencing vegetative state due to the no referral to the forensic medicine and the failure to record the cause of vegetative state in the case that led to their exclusion.
Conclusions
The mean of survival rate of patients with vegetative state referred to forensic medicine centers in Tehran from the beginning of 2008 to the end of 2017 is 6.39±1.50 months. The minimum survival rate after vegetative state has been 2 months and the maximum has been 192 months (16 years). Therefore, the average cost of maintaining them can be estimated.
Acknowledgments
The authors acknowledge all the respected staff of Forensic Medicine in Tehran who contributed to the data collection.
Conflict of interest
None
Ethical Permissions
The ethics code for this article is IR.LMO.REC.1397.75.
Funding Sources
None