Abstract
Background: Patients who are in a coma, a vegetative state or a minimally conscious state present a clinical challenge for neurological assessment, which is a prerequisite for establishing a prognosis and planning management. Several scales have been developed to evaluate these patients. The Wessex Head Injury Matrix is a comprehensive tool but is currently available only in the French and English languages. The aim of this study was to translate and evaluate the reliability of the Italian version of the scale. Methods: The original scale was translated according to a standard protocol: three separate translations were made, and a selected version was back-translated to check for any errors in order to obtain the most accurate Italian translation. A final back translation of the agreed version was made as a further check. The final version was then administered blind to a consecutive series of patients with severe acquired brain injury by two examiners. Inter-rater and test-retest reliability were assessed using a weighted Cohen’s kappa (Kw). Concurrent validity of the WHIM was evaluated by ρ Spearman’s correlation coefficient using the Glasgow Coma Scale (GCS) and the Coma Recovery Scale Revised (CRS-R) as the available gold standard. Results: Twenty-four patients (12 males and 12 females; mean age 59.9 ± 20.1; mean duration from index event 17.7 ± 20.0 days) with stroke (n = 15), traumatic brain injury (n = 7) and anoxic encephalopathy (n = 2) were included. Inter-rater [Kw 0.80 (95% CI 0.75–0.84)] and test-retest reliability [Kw 0.77 (95% CI 0.72–0.81)] showed good values. WHIM total scores correlated significantly with total scores on the GCS (ρ = 0.776; p < 0.001) and the CRS-R (ρ = 0.881; p < 0.001) demonstrating concurrent validity; Conclusion: The Italian version of the scale is now available for clinical practice and research.
Highlights
Assessment of patients with disorders of consciousness is challenging due to the complexity of managing patients who survive a severe acquired brain injury
Patients may be medically unstable and have medical comorbidities including those compromising mobility, such as spasticity, heterotopic ossification, fractures, joint disease and previous disability. These comorbidities, in particular, may hinder purposeful movements and the following of commands that are cardinal signs that can distinguish between unresponsive wakefulness syndrome (UWS)
The two raters were blinded to the diagnosis of the state of consciousness, that was made by a third examiner using the Glasgow Coma Scale (GCS)
Summary
Assessment of patients with disorders of consciousness (coma, unresponsive wakefulness syndrome and minimally conscious state) is challenging due to the complexity of managing patients who survive a severe acquired brain injury. Further difficulties in the assessment of patients arise from the recent identification of new diagnostic categories based on the use of paraclinical testing (i.e., functional magnetic resonance imaging, positron emission tomography, EEG or evoked potentials), which has led to the identification of a subgroup of patients with a presumed covert awareness who do not show behavioral evidence of consciousness or communication. Specific evidence in this area has been obtained among patients who maintain preserved cognitive skills, such as the ability to perform motor imagery tasks (e.g., tennis playing), despite the absence of any signs of self-expression. The objective of this study was to develop and evaluate the reliability of the Italian version of the WHIM and to make it available for clinical practice and research
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