Abstract
BackgroundTo evaluate the utility of the revised coma remission scale (CRS-r), together with other clinical variables, in predicting emergence from disorders of consciousness (DoC) during intensive rehabilitation care.MethodsData were retrospectively extracted from the medical records of patients enrolled in a specialized intensive rehabilitation unit. 123 patients in a vegetative state (VS) and 57 in a minimally conscious state (MCS) were included and followed for a period of 8 weeks. Demographical and clinical factors were used as outcome measures. Univariate and multivariate Cox regression models were employed for examining potential predictors for clinical outcome along the time.ResultsVS and MCS groups were matched for demographical and clinical variables (i.e., age, aetiology, tracheostomy and route of feeding). Within 2 months after admission in intensive neurorehabilitation unit, 3.9% were dead, 35.5% had a full recovery of consciousness and 66.7% remained in VS or MCS. Multivariate analysis demonstrated that the best predictor of functional improvement was the CRS-r scores. In particular, patients with values greater than 12 at admission were those with a favourable likelihood of emergence from DoC.ConclusionsOur study highlights the role of the CRS-r scores for predicting a short-term favorable outcome.
Highlights
To evaluate the utility of the revised coma remission scale (CRS-r), together with other clinical variables, in predicting emergence from disorders of consciousness (DoC) during intensive rehabilitation care
After a period of coma resulting from severe acquired cerebrovascular injury of vascular, traumatic or anoxic origin, patients may present an evolution through three ascending disorders of consciousness (DoC) levels: coma, vegetative state (VS) and minimal conscious state (MCS) [1]
All patients were consecutively admitted to the intensive rehabilitation unit (IRU) of the Institute S
Summary
To evaluate the utility of the revised coma remission scale (CRS-r), together with other clinical variables, in predicting emergence from disorders of consciousness (DoC) during intensive rehabilitation care. One of the main targets in the clinical management of patients with DoC is to identify which medical prognostic features might best predict long-term neurologic and functional positive outcome [4]. This was done in order to determine: i) algorithmic approaches to patient treatment; ii) the optimal clinical care and setting to improve outcomes and iii) the risk of long-term severe disability and institutionalization, which increases hospital costs [5]. One of the best diagnostic and prognostic tools useful to distinguish MCS from VS is the Coma Recovery Scale-Revised (CRS-r) [6]
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