Brain Injury, April 2010; 24(4): 620–624 The Morfeo Study: A 1-year follow-up of complications of vegetative state in a dedicated facility M. P. FANTINI 1 , F. BUGGI 2 , E. CARRETTA 1 , L. LORENZINI 1 , R. PIPERNO 3 , N. MATERA 4 , M. R. LEO 4 , & D. L. COULTER 5 1 University of Bologna, Italy, 2 Sant’Orsola-Malpighi Hospital, Bologna, Italy, 3 Maggiore Hospital, Bologna, Italy, 4 Santa Viola Hospital, Bologna, Italy, and 5 Harvard Medical School, Boston, MA, USA (Received 7 August 2009; revised 21 January 2010; accepted 25 January 2010) Abstract Objectives: Vegetative State (VS) implies significant issues. The aim of the MORFEO study is to identify the most relevant complications in VS patients and to supply clinicians and policy-makers with data derived from the analysis of a cohort of patients treated in a dedicated long-term facility setting. Methods: A cohort of 22 VS patients treated between 2003 and 2007 were enrolled and followed up for 1 year. The information recorded were: Disability Rating Scale (DRS), Levels of Cognitive Functioning (LCF), pressure sores, nutritional status, neurological complications, articular complications (passive range of motion–ROM), deep-vein thrombosis and infections. The Kolmogorov-Smirnov test was used to verify the normal distribution of the variables. The indicators of complications were analysed with the Friedman test (continuous variables) and with the Cochran Q test (dichotomous variables). Results: DRS and LCF values showed no significant variation. The number of pressure sores decreased. The nutritional status remained satisfying. The ROM worsened in lower limb joints; a trend (p ¼ ns) towards an improved range was observed in shoulders and elbows. Fifteen infections were recorded. Conclusions: The data that proved significant suggest a minimum set of quality-of-care indicators in VS patients: pressure sores follow-up, nutritional status, ROM and incidence of infections. Keywords: Vegetative state, rehabilitation, complications, quality of life, coma Introduction The Vegetative State (VS) is a clinical condition of complete unawareness of the self and the environ- ment, accompanied by sleep–wake cycles, with either complete or partial preservation of hypothalamic and brain-stem autonomic functions [1] and was reported by Jennett [2] to be the rarest form of disability in patients rescued from life-threatening severe brain damage by resuscitation and intensive care. It raises significant diagnostic, organizational and therapeutic issues, as well as controversial bioethical and legal ones. VS can be partially or totally reversible or it may progress to a persistent vegetative state or death [3]. Persistent vegetative state is a condition that is basically unchanged at 1 month from the acute event but does not imply irreversibility, whereas permanent vegetative state implies the prediction that the patient will not recover. VS is considered irreversible after 3 months following a non-traumatic brain injury and 12 months following a traumatic one [1]. Just how many patients suffering from VS are present in a community is difficult to calculate because such patients are widely distributed among various institutions with differing specialities as well as in home care [2]. This implies that patients are treated Correspondence: Giuliana Fabbri, MD, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy. Tel: þ393282287810. Fax: þ390512094839. E-mail: giuliana.fabbri@unibo.it ISSN 0269–9052 print/ISSN 1362–301X online ß 2010 Informa Healthcare Ltd. DOI: 10.3109/02699051003652831