Abstract
Objectives
To evaluate the prognostic utility of serial assessment on the Coma Recovery Scale–Revised
(CRS-R) during the first 4 weeks of intensive rehabilitation in patients surviving
a severe brain injury.
Design
Prospective cohort study.
Setting
An intensive rehabilitation unit.
Participants
Patients (N=110) consecutively admitted to the intensive rehabilitation unit. Inclusion
criteria were (1) a diagnosis of unresponsive wakefulness syndrome (UWS) or minimally
conscious state (MCS) caused by an acquired brain injury, and (2) aged >18 years.
Interventions
All patients underwent clinical evaluations using the Italian version of the CRS-R
during the first month of hospital stay.
Main Outcome Measures
Behavioral classification on the CRS-R and the score on the Glasgow Outcome Scale
(GOS) at final discharge. Patients transitioning from UWS to MCS or emergence from
MCS (E-MCS), and from MCS to E-MCS were classified as patients with improved responsiveness (IR).
Results
After a mean ± SD hospital stay of 5.3±2.7 months, 59 of 110 patients (53.6%) achieved
IR. In the multivariable analysis, a higher CRS-R score change at week 4 (odds ratio
=1.99; 95% confidence interval [CI], 1.49–2.66; P<.001) was the only significant predictor of IR at discharge. Fifty-three patients
(48.2%) were classified as severely impaired at discharge (GOS=3). In the multivariable
analysis, higher GOS scores were related to a higher CRS-R score at admission (B=.051;
95% CI, .027–.074; P<.001), a higher CRS-R score change at week 4 (B=.087; 95% CI, .064–.110; P<.001), and an absence of severe infections (B=–.477; 95% CI, –.778 to –.176; P=.002).
Conclusions
An improvement on the total CRS-R score and on different subscales across the first
4 weeks of inpatient rehabilitation discriminates patients who will have a better
outcome at discharge, providing information for rehabilitation planning and for communication
with patients and their caregivers.
Keywords
List of abbreviations:
CI (confidence interval), CRS-R (Coma Recovery Scale–Revised), E-MCS (emergence from minimally conscious state), GOS (Glasgow Outcome Scale), IR (improved responsiveness), MCS (minimally conscious state), UWS (unresponsive wakefulness syndrome)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 08, 2018
Footnotes
Supported by the Italian Ministry of Health (Current Research 2014-2016).
Disclosures: none.
Identification
Copyright
© 2018 by the American Congress of Rehabilitation Medicine
