Abstract
BackgroundThe aim of the study was to determine the role of the Coma Recovery Scale-Revised (CRS-R) in the prediction of functional status at the end of neurological early rehabilitative treatment.MethodsPatients consecutively admitted to intensive or intermediate care units of a neurological rehabilitation center were enrolled in the study. Consciousness and functional status were assessed with the Coma Recovery Scale-Revised (CRS-R) and the Early Rehabilitation Barthel Index (ERBI), respectively. Both assessments were carried out weekly within the first month and at the end of early rehabilitation. Patient and clinical data were entered into a binary logistic regression model to predict functional status at discharge.Results327 patients (112 females, 215 males) with a median age of 63 years (IQR = 53–75) and a median disease duration of 18 days (IQR = 12–28) were included. Most patients suffered from stroke (59 %), followed by traumatic brain injury (31 %), and hypoxic ischemic encephalopathy (10 %). Upon admission, 12 % were diagnosed as comatose, 31 % as unresponsive wakefulness syndrome (UWS), 35 % as minimally conscious state (MCS) and 22 % already emerged from MCS (eMCS). Of all patients undergoing complete early rehabilitative treatment (n = 180), 72 % showed improvements in level of consciousness (LOC). In this group, age, initial CRS-R score and gains in CRS-R score after four weeks independently predicted functional outcome at discharge.ConclusionsThe study confirms the relevance of the CRS-R score for functional outcome prediction. High CRS-R scores and young age facilitate functional improvements and increase the probability to continue treatment in subsequent rehabilitation phases. Moreover, results indicate that recovery might occur over a period of time that extends beyond acute care.
Highlights
The aim of the study was to determine the role of the Coma Recovery Scale-Revised (CRS-R) in the prediction of functional status at the end of neurological early rehabilitative treatment
In Germany, neurological rehabilitation is offered in six phases [25]: acute treatment, neurological early rehabilitation, subsequent rehabilitation, occupational rehabilitation and long-term care
17 patients had to be excluded from further analyses due to incomplete CRS-R data (n = 8 patients declined to be examined in one of the follow-up assessments [these patients had a total CRS-R score ≥ 10 in the first assessment and improved in consciousness during the following days enabling them to express their unwillingness to be examined]; n = 6 patients were set on contact precautions due to colonization with multi-resistant bacteria, and n = 3 patients were discharged prematurely at own request)
Summary
The aim of the study was to determine the role of the Coma Recovery Scale-Revised (CRS-R) in the prediction of functional status at the end of neurological early rehabilitative treatment. Over the last 20 years, the number of survivors after severe brain damage increased due to advances in emergency medicine, intensive care and neurosurgical procedures [1]. These patients are in an altered state of consciousness. Coma is an acute state of unarousable unresponsiveness, which usually does not last longer than a few days or weeks. Comatose patients have their eyes closed and show no behavioral signs of self-related or environmental awareness [2]. Patients emerged from MCS (eMCS) when they regained the ability to communicate and/ or use objects functionally [4]
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