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dc.contributor.authorArzi, Anaten
dc.contributor.authorRozenkrantz, Lironen
dc.contributor.authorGorodisky, Lioren
dc.contributor.authorRozenkrantz, Daniten
dc.contributor.authorHoltzman, Yaelen
dc.contributor.authorRavia, Aharonen
dc.contributor.authorBekinschtein, Tristanen
dc.contributor.authorGalperin, Tatyanaen
dc.contributor.authorKrimchansky, Ben-Zionen
dc.contributor.authorCohen, Galen
dc.contributor.authorOksamitni, Annaen
dc.contributor.authorAidinoff, Elenaen
dc.contributor.authorSacher, Yaronen
dc.contributor.authorSobel, Noamen
dc.date.accessioned2020-05-06T23:30:07Z
dc.date.available2020-05-06T23:30:07Z
dc.date.issued2020-05en
dc.identifier.issn0028-0836
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/305055
dc.description.abstractIt is often difficult to determine state of consciousness following severe brain injury; is the patient vegetative, or perhaps minimally conscious1? and if vegetative, will the patient recover? These diagnoses and prognoses are critical, as they determine therapeutic strategies such as pain management, and can underlie end-of-life decisions. And yet, troublingly, there is up to 40% error in determining state of consciousness in brain-injured patients. Olfaction relies on deep brain structures that are involved in basic mechanisms of arousal6, and therefore we hypothesized that it may serve as a biomarker for consciousness. To test olfaction in brain injured patients we used a non-verbal non-task-dependent measure known as the sniff-response8–11, namely automatic sniff modulations to account for odorant content. By precisely measuring odorant-dependent sniffing we gain a sensitive measure of olfactory function10–15. Here we applied this measure repeatedly over time in 43 severely brain-injured patients. We found that sniff-responses significantly discriminated between vegetative and minimally conscious states at the group level (p < 0.0001, effect-size r = 0.63). More remarkably, at the single patient level, if a vegetative patient had a sniff-response, this indicated future regaining of consciousness at 100% specificity. Finally, olfactory sniff responses predicted long-term survival rates at 92% accuracy (X2 = 14.5, p = 0.0001, Cramer's V effect size = 0.45). These results stress the primality of olfaction in functioning of the human brain, and provide for an accessible bedside tool that signals consciousness and recovery in brain-injured patients.
dc.format.mediumPrint-Electronicen
dc.languageengen
dc.publisherSpringer Nature
dc.rightsAll rights reserved
dc.rights.uri
dc.subjectHumansen
dc.subjectPersistent Vegetative Stateen
dc.subjectBrain Injuriesen
dc.subjectDiagnostic Errorsen
dc.subjectPrognosisen
dc.subjectSensitivity and Specificityen
dc.subjectSurvival Analysisen
dc.subjectConsciousnessen
dc.subjectArousalen
dc.subjectSmellen
dc.subjectRecovery of Functionen
dc.subjectAdulten
dc.subjectFemaleen
dc.subjectMaleen
dc.subjectOlfactory Perceptionen
dc.subjectOdorantsen
dc.titleOlfactory sniffing signals consciousness in unresponsive patients with brain injuries.en
dc.typeArticle
prism.endingPage433
prism.issueIdentifier7809en
prism.publicationDate2020en
prism.publicationNameNatureen
prism.startingPage428
prism.volume581en
dc.identifier.doi10.17863/CAM.52137
dcterms.dateAccepted2020-02-26en
rioxxterms.versionofrecord10.1038/s41586-020-2245-5en
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden
rioxxterms.licenseref.startdate2020-05en
dc.contributor.orcidArzi, Anat [0000-0003-1005-1752]
dc.contributor.orcidRavia, Aharon [0000-0003-2183-9254]
dc.contributor.orcidBekinschtein, Tristan [0000-0001-5501-8628]
dc.contributor.orcidSobel, Noam [0000-0002-3232-9391]
dc.identifier.eissn1476-4687
rioxxterms.typeJournal Article/Reviewen
cam.orpheus.successWed May 13 08:53:11 BST 2020 - Embargo updated*
rioxxterms.freetoread.startdate2020-10-29


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