Abstract
BackgroundPrevious studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high rates of misdiagnosis by clinical consensus. The aim of this study was to investigate the proportion of misdiagnosis by clinical consensus compared to repeated behavior-scale assessments in patients with prolonged disorders of consciousness (DOC).MethodsPatients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical-consensus diagnosis. Trained professionals used the CRS-R to evaluate the consciousness levels of the enrolled patients repeatedly (≥5 times) within a week. Based on the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Finally, the relationship between the results of the CRS-R and the clinical consensus were analyzed.ResultsIn this study, 137 patients with a clinical-consensus diagnosis of prolonged DOC were enrolled. It was found that 24.7% of patients with clinical UWS were actually in MCS after a single CRS-R behavior evaluation, while the repeated CRS-R evaluation results showed that the proportion of misdiagnosis of MCS was 38.2%. A total of 16.7% of EMCS patients were misdiagnosed with clinical MCS, and 1.1% of EMCS patients were misdiagnosed with clinical UWS.ConclusionsThe rate of the misdiagnosis by clinical consensus is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool in daily procedures.Trial registrationClinicalTrials.gov ID: NCT04139239; Registered 24 October 2019 - Retrospectively registered.
Highlights
Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high rates of misdiagnosis by clinical consensus
minimally conscious state (MCS) can be further divided into MCS plus (MCS+) and MCS minus (MCS-) subtypes according to the complexity of the behavioral response [5]
After the single CRS-R behavior evaluation, it was found that the proportion of misdiagnosis of clinical MCS was 24.7%, while the repeated CRS-R evaluation results showed that the proportion of misdiagnosis of clinical MCS was 38.2%
Summary
Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high rates of misdiagnosis by clinical consensus. The aim of this study was to investigate the proportion of misdiagnosis by clinical consensus compared to repeated behavior-scale assessments in patients with prolonged disorders of consciousness (DOC). There is no clear evidence of awareness or directed response to external stimuli; the presence of repetitive non-reflexive behavioral responses suggests a transition to the MCS state. MCS patients can generally show some behavioral response characteristics related to consciousness [4, 11] In these patients, there is weak and fluctuating but definite behavioral evidence of a distinct sense of self or of the environment, such as the ability to visually track objects and the ability to understand verbal information and follow instructions. Once patients can communicate functionally or can use functional objects, they are diagnosed with emergence from MCS (EMCS) [12, 13]
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