Abstract
Objective
To explore the prognostic value of the Coma Recovery Scale-Revised (CRS-R) in predicting
disability outcomes in patients with severe traumatic brain injury using the Disability
Rating Scale (DRS).
Design
Secondary analysis including linear and logistic regressions were performed.
Setting
Data were collected in a previous clinical trial.
Participants
One hundred eighty-four participants across 3 countries (N=184).
Main Outcome Measures
Disability Rating Scales.
Results
Analyses showed an inverse relation between CRS-R scores obtained at baseline and
change in DRS scores at 6 weeks. Similarly, changes in CRS-R scores between baseline
and 4 weeks were also found to have an inverse relation to change in DRS scores at
6 weeks.
Conclusions
This study generates a tool that can be used to predict the probability that a patient
with severe traumatic brain injury lands in 1 of 3 disability categories. The CRS-R
may be useful in prognostication of disability in patients with severe traumatic brain
injury.
Keywords
List of abbreviations:
CRS (Coma Recovery Scale), DoC (disorders of consciousness), DRS (Disability Rating Scale), GOS (Glasgow Outcome Scale), MCS (minimally conscious state), VS (vegetative state)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of severe traumatic brain injury.J Neurosurg Sci. 2018; 62: 535-541
- The minimally conscious state: definition and diagnostic criteria.Neurology. 2002; 58: 349-353
- Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit.BMJ. 1996; 313: 13-16
- Accuracy of diagnosis of persistent vegetative state.Neurology. 1993; 43: 1465-1467
- Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment.BMC Neurol. 2009; 9: 35
- Medical decision making in the vegetative state: withdrawal of nutrition and hydration.NeuroRehabilitation. 2004; 19: 299-304
- The vegetative and minimally conscious states: consensus-based criteria for establishing diagnosis and prognosis.NeuroRehabilitation. 2004; 19: 293-298
- The minimally conscious state and recovery potential: a follow-up study 2 to 5 years after traumatic brain injury.Arch Phys Med Rehabil. 2005; 86: 746-754
- Natural history of recovery from brain injury after prolonged disorders of consciousness: outcome of patients admitted to inpatient rehabilitation with 1-4 year follow-up.Prog Brain Res. 2009; 177: 73-88
- Long-term outcomes of chronic minimally conscious and vegetative states.Neurology. 2010; 75: 246-252
- Functional outcomes in traumatic disorders of consciousness: 5-year outcomes from the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems.Arch Phys Med Rehabil. 2013; 94: 1855-1860
- Monitoring rate of recovery to predict outcome in minimally responsive patients.Arch Phys Med Rehabil. 1991; 72: 897-901
- The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility.Arch Phys Med Rehabil. 2004; 85: 2020-2029
- Reliability and diagnostic characteristics of the JFK coma recovery scale-revised: exploring the influence of rater's level of experience.J Head Trauma Rehabil. 2010; 25: 349-356
- Coma Recovery Scale-Revised: evidentiary support for hierarchical grading of level of consciousness.Arch Phys Med Rehabil. 2014; 95233541
- Can we scientifically and reliably measure the level of consciousness in vegetative and minimally conscious States? Rasch analysis of the coma recovery scale-revised.Arch Phys Med Rehabil. 2013; 94 (e1): 527-535
- Detection and interpretation of impossible and improbable Coma Recovery Scale-Revised Scores.Arch Phys Med Rehabil. 2016; 97 (e4): 1295-1300
- A French validation study of the Coma Recovery Scale-Revised (CRS-R).Brain Inj. 2008; 22: 786-792
- Validation of the Italian version of the Coma Recovery Scale-Revised (CRS-R).Brain Inj. 2011; 25: 488-495
- Assessment of comatose patients: a Portuguese instrument based on the Coma Recovery Scale - revised and using nursing standard terminology.J Adv Nurs. 2011; 67: 1129-1141
- A Spanish validation of the Coma Recovery Scale-Revised (CRS-R).Brain Inj. 2014; 28: 1744-1747
- A validation of the Polish version of the Coma Recovery Scale-Revised (CRSR).Brain Inj. 2018; 32: 242-246
- An Italian multicentre validation study of the coma recovery scale-revised.Eur J Phys Rehabil Med. 2015; 51: 627-634
- Early detection of consciousness in patients with acute severe traumatic brain injury.Brain. 2017; 140: 2399-2414
- Automated EEG entropy measurements in coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state.Funct Neurol. 2011; 26: 25-30
- Late recovery after traumatic, anoxic, or hemorrhagic long-lasting vegetative state.Neurology. 2010; 75: 239-245
- Behavioural improvements with thalamic stimulation after severe traumatic brain injury.Nature. 2007; 448: 600-603
- Disability rating scale for severe head trauma: coma to community.Arch Phys Med Rehabil. 1982; 63: 118-123
- Assessment of coma and impaired consciousness. A practical scale.Lancet. 1974; 2: 81-84
- Does the FOUR score correctly diagnose the vegetative and minimally conscious states?.Ann Neurol. 2006; 60 (author reply 745): 744-745
- Validation of a new coma scale: the FOUR score.Ann Neurol. 2005; 58: 585-593
- The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury.Clin Rehabil. 2000; 14: 408-416
- Sensitivity and specificity of the Coma Recovery Scale–Revised total score in detection of conscious awareness.Arch Phys Med Rehabil. 2016; 97 (e1): 490-492
- Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research.Arch Phys Med Rehabil. 2010; 91: 1795-1813
- Behavioral recovery in disorders of consciousness: a prospective study with the Spanish version of the Coma Recovery Scale-Revised.Arch Phys Med Rehabil. 2012; 93 (e12): 428-433
- Predictors of recovery of responsiveness in prolonged anoxic vegetative state.Neurology. 2013; 80: 464-470
- Score on Coma Recovery Scale-Revised at admission predicts outcome at discharge in intensive rehabilitation after severe brain injury.Brain Inj. 2018; 32: 730-734
- Improvement on the Coma Recovery Scale-Revised during the first four weeks of hospital stay predicts outcome at discharge in intensive rehabilitation after severe brain injury.Arch Phys Med Rehabil. 2018; 99: 914-919
- Glasgow Outcome Scale and Disability Rating Scale: comparative usefulness in following recovery in traumatic head injury.Arch Phys Med Rehabil. 1985; 66: 35-37
- The Glasgow Outcome at Discharge Scale: an inpatient assessment of disability after brain injury.J Neurotrauma. 2013; 30: 970-974
- Placebo-controlled trial of amantadine for severe traumatic brain injury.N Engl J Med. 2012; 366: 819-826
- Reliability and validity of the Disability Rating Scale and the Levels of Cognitive Functioning Scale in monitoring recovery from severe head injury.Arch Phys Med Rehabil. 1987; 68: 94-97
- Prognosis of rehabilitation outcome in head injury using the Disability Rating Scale.Arch Phys Med Rehabil. 1994; 75: 156-163
- Predictive validity of Rappaport's Disability Rating Scale in subjects with acute brain dysfunction.Phys Ther. 1984; 64: 1357-1360
- Outcome prediction in disorders of consciousness: the role of the coma recovery scale revised.BMC Neurol. 2019; 19: 68
- Predictive factors for 1-year outcome of a cohort of patients with severe traumatic brain injury (TBI): results from the PariS-TBI study.Brain Inj. 2013; 27: 1000-1007
- Prognostic factors of long-term functioning and productivity after traumatic brain injury: a systematic review of prospective cohort studies.Clin Rehabil. 2007; 21: 1024-1037
Article info
Publication history
Published online: January 31, 2023
Accepted:
January 4,
2023
Received in revised form:
December 19,
2022
Received:
May 26,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Preliminary study data and analysis was presented at the Loma Linda Annual Research Symposium in June 2021 by Susan Onami, MD and then in June 2022 by Christine Koh-Pham, DO. The original proposal for calculating DRS probability using log-odds and the original request for data access was submitted by Duc Tran in 2019.
Disclosures: none.
Identification
Copyright
© 2023 by the American Congress of Rehabilitation Medicine.
