Article (Scientific journals)
The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated coma-recovery scale-revised assessment
Wang, J.; Hu, X.; Hu, Z. et al.
2020In BMC Neurology, 20 (1)
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Keywords :
Coma-recovery scale-revised; Disorders of consciousness; Minimally conscious state; Misdiagnosis; Unresponsive wakefulness syndrome
Abstract :
[en] Background: 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). Methods: Patients 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. Results: In 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. Conclusions: The 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 registration: ClinicalTrials.gov ID: NCT04139239; Registered 24 October 2019 - Retrospectively registered. © 2020 The Author(s).
Research center :
CHU de Liège-Centre du Cerveau² - ULiège
Disciplines :
Neurology
Author, co-author :
Wang, J.;  International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, 310036, China
Hu, X.;  Rehabilitation Center for Brain Damage, Wujing Hospital of Hangzhou City, Hangzhou, China
Hu, Z.;  International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, 310036, China
Sun, Z.;  International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, 310036, China
Laureys, Steven  ;  Université de Liège - ULiège > GIGA Consciousness-Coma Science Group
Di, Haibo;  International Unresponsive Wakefulness Syndrome and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, 310036, China
Language :
English
Title :
The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated coma-recovery scale-revised assessment
Publication date :
2020
Journal title :
BMC Neurology
eISSN :
1471-2377
Publisher :
BioMed Central
Volume :
20
Issue :
1
Peer reviewed :
Peer Reviewed verified by ORBi
European Projects :
H2020 - 778234 - DoCMA - Disorders of Consciousness (DoC): enhancing the transfer of knowledge and professional skills on evidence-based interventions and validated technology for a better management of patients
H2020 - 785907 - HBP SGA2 - Human Brain Project Specific Grant Agreement 2
Name of the research project :
DOCMA project (EU-H2020-MSCA-RISE-778234)
National High Technology Research and Development Program of China (2015AA020514)
Zhejiang Province Chinese Medicine Science and Technology Program Project (2018ZB101)
Funders :
NSCF - National Natural Science Foundation of China [CN]
FRB - King Baudouin Foundation [BE]
UE - Union Européenne [BE]
Funding text :
This study was supported by the National Natural Science Foundation of China (81471100, 811247008), the National High Technology Research and Development Program of China (2015AA020514), the National Natural Science Foundation of China (81920108023), Hangzhou Normal University (2018PYXML007), Zhejiang Province Chinese Medicine Science and Technology Program Project (2018ZB101), Zhejiang Basic Public Interest Research Program Project (LGF20H090017), the European Union’s Horizon 2020 Framework Program for Research and Innovation under the Specific Grant Agreement (Human Brain Project SGA2, 785907), the fund Generet, the King Baudouin Foundation, and the DOCMA project (EU-H2020-MSCA-RISE-778234). The funders had no role in study design, data collection and analysis, interpretation of data, decision to publish or preparation of the manuscript.
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