A proposal for measuring chronic disorders of consciousness in Brazil

Introduction: Chronic disorders of consciousness (PDOC), vegetative state (VS) and minimally conscious state (MCS) persisting ≥ 28 days after severe traumatic intracranial injury are under‑recognized, with misdiagnosis in up to 40% of cases. Objective: The aim of this study was to estimate the annual number of Brazilians living with PDOC following severe traumatic intracranial injury. Methods: SIH‑DATASUS TabNet provided 1,18,152 hospitalizations for traumatic intracranial injury (Mar 2024–Feb 2025). International cohorts reporting 8–14% severe cases (GCS ≤ 8) and regional data showing ~14.5% severe incidence in Santa Catarina informed a 10% severe‑TBI rate (≈11,815; sensitivity 8–14%). To model VS at 28 days, a pooled VS proportion of 10% (range 6–13%) from Coma Recovery Scale–Revised (CRS‑R) assessments was applied. MCS counts were estimated using a 1.3:1 MCS:VS ratio—reflecting observed ratios in CENTER‑TBI (8.9 vs. 6.8%), an Italian rehabilitation cohort (43.3 vs. 32.5%), and TRACK‑TBI (~ 16 vs. 12%). Sensitivity analyses covered full parameter ranges. Results: Under central assumptions, projections indicate ~ 1,182 VS and ~ 1,537 MCS cases annually, totalling ~ 2,719 new PDOC patients per year (1.3 per 1,00,000; range 1 395–4,310). Post‑traumatic VS/MCS recovery occurs in 38% at 3 months, 67% at 6 months, and 78% at 12 months—implying ~ 598 individuals will require care beyond 1 year. Conclusion: This first structured quantification identifies ~2,700 PDOC cases annually in Brazil ≈21% of 13,089 specialized beds (3,598 rehabilitation; 4,980 neurosurgery; 4,511 neurology), revealing a critical capacity gap. The absence of dedicated PDOC research centers and coordinated care networks, unlike the United States, Europe, and China, underscores the need for standardized diagnostic protocols, comprehensive CRS‑R training, and establishment of a national PDOC registry to guide resource allocation for long‑term neurorehabilitation and inform evidence‑based health policy.