Coma recovery scale-r: variability in the disorder of consciousness

• Published in: BMC neurology Vol. 15; no. 1; p. 186
• Main Authors: Cortese, MD, Riganello, F., Arcuri, F., Pugliese, ME, Lucca, LF, Dolce, G., Sannita, WG
• Format: Journal Article
• Language: English
• Published: London BioMed Central 08.10.2015; BioMed Central Ltd
• Subjects: Adult; Aged; Analysis; Care and treatment; Coma; Complications and side effects; Diagnosis; Disability Evaluation; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neurochemistry; Neurology; Neurosurgery; Persistent vegetative state; Persistent Vegetative State - classification; Prognosis; Research Article; Retrospective Studies; Risk factors; Vegetative state; Minimally conscious state; Disorders of consciousness; Variability; CRS-r
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-015-0455-5

Background Despite evidence from neuroimaging research, diagnosis and early prognosis in the vegetative (VS/UWS) and minimally conscious (MCS) states still depend on the observation of clinical signs of responsiveness. Multiple testing has documented a systematic variability during the day in the incidence of established signs of responsiveness. Spontaneous fluctuations of the Coma Recovery Scale-revised (CRS-r) scores are conceivable. Methods We retrospectively analyzed the CRS-r repeatedly administered to 7 VS/UWS and 12 MCS subjects undergoing systematic observation during a conventional 13 weeks. rehabilitation plan. Results The CRS-r global, visual and auditory scores were found higher in the morning than at the afternoon administration in both VS/UWS and MCS subgroups over the entire period of observation. The probability for a VS/UWS subject of being classified as MCS at the morning testing at least once during the 13 weeks. observation was as high as 30 %, i.e., compatible with the reported misdiagnosis rate between the two clinical conditions. Conclusions Multiple CRS-r testing is advisable to minimize the risk of misclassification; estimates of spontaneous variability could be used to characterize with greater accuracy patients with disorder of consciousness and possibly help optimize the rehabilitation plan.