Article (Scientific journals)
Outcome prediction of consciousness disorders in the acute stage based on a complementary motor behavioural tool
Pignat, Jean-Michel; Mauron, Etienne; Jöhr, Jane et al.
2016In PLoS ONE, 11 (6)
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Keywords :
Article; Coma Recovery Scale Revised; Motor Behaviour Tool; Consciousness Disorders; Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Physical Examination; Prognosis; Recovery of Function; Treatment Outcome; Young Adult
Abstract :
[en] Introduction Attaining an accurate diagnosis in the acute phase for severely brain-damaged patients presenting Disorders of Consciousness (DOC) is crucial for prognostic validity; such a diagnosis determines further medical management, in terms of therapeutic choices and end-of-life decisions. However, DOC evaluation based on validated scales, such as the Revised Coma Recovery Scale (CRS-R), can lead to an underestimation of consciousness and to frequent misdiagnoses particularly in cases of cognitive motor dissociation due to other aetiologies. The purpose of this study is to determine the clinical signs that lead to a more accurate consciousness assessment allowing more reliable outcome prediction. Methods From the Unit of Acute Neurorehabilitation (University Hospital, Lausanne, Switzerland) between 2011 and 2014, we enrolled 33 DOC patients with a DOC diagnosis according to the CRS-R that had been established within 28 days of brain damage. The first CRS-R assessment established the initial diagnosis of Unresponsive Wakefulness Syndrome (UWS) in 20 patients and a Minimally Consciousness State (MCS) in the remaining13 patients. We clinically evaluated the patients over time using the CRS-R scale and concurrently from the beginning with complementary clinical items of a new observational Motor Behaviour Tool (MBT). Primary endpoint was outcome at unit discharge distinguishing two main classes of patients (DOC patients having emerged from DOC and those remaining in DOC) and 6 subclasses detailing the outcome of UWS and MCS patients, respectively. Based on CRS-R and MBT scores assessed separately and jointly, statistical testing was performed in the acute phase using a non-parametric Mann-Whitney U test; longitudinal CRS-R data were modelled with a Generalized Linear Model. Results Fifty-five per cent of the UWS patients and 77% of the MCS patients had emerged from DOC. First, statistical prediction of the first CRS-R scores did not permit outcome differentiation between classes; longitudinal regression modelling of the CRS-R data identified distinct outcome evolution, but not earlier than 19 days. Second, the MBT yielded a significant outcome predictability in the acute phase (p<0.02, sensitivity>0.81). Third, a statistical comparison of the CRS-R subscales weighted by MBT became significantly predictive for DOC outcome (p<0.02). Discussion The association of MBT and CRS-R scoring improves significantly the evaluation of consciousness and the predictability of outcome in the acute phase. Subtle motor behaviour assessment provides accurate insight into the amount and the content of consciousness even in the case of cognitive motor dissociation. Copyright: © 2016 Pignat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Disciplines :
Neurosciences & behavior
Author, co-author :
Pignat, Jean-Michel;  Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
Mauron, Etienne;  Faculty of Medicine, Lausanne University, Lausanne, Switzerland
Jöhr, Jane;  Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
Gilart de Keranflec'h, Charlotte
Van De Ville, Dimitri
Preti, Maria Giulia;  Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland, Faculty of Medicine, University of Geneva, Geneva, Switzerland
Meskaldji, Djalel E.;  Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland, Faculty of Medicine, University of Geneva, Geneva, Switzerland
Hömberg, Volker;  Department of Neurology, SRH-Gesundheitszentrum, Bad Wimpfen, Germany
Laureys, Steven  ;  Université de Liège - ULiège > GIGA : Coma Group
Draganski, Bogdan;  Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
Frackowiak, Richard;  Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
Diserens, Karin;  Acute Neurorehabilitation Unit, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
Language :
English
Title :
Outcome prediction of consciousness disorders in the acute stage based on a complementary motor behavioural tool
Publication date :
2016
Journal title :
PLoS ONE
eISSN :
1932-6203
Publisher :
Public Library of Science
Volume :
11
Issue :
6
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
SNSF - Swiss National Science Foundation [CH]
Available on ORBi :
since 29 April 2020

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