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.; Sun, Z.; Laureys, Steven; Di, Haibo

doi:10.1186/s12883-020-01924-9

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.

2020 • In BMC Neurology, 20 (1)

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/253111

DOI
10.1186/s12883-020-01924-9

PubMed
32919461

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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/Unit :

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 :

Issue :

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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Bibliography

van Erp WS, Lavrijsen JC, van de Laar FA, Vos PE, Laureys S, Koopmans RT. The vegetative state/unresponsive wakefulness syndrome: a systematic review of prevalence studies. Eur J Neurol. 2014;21(11):1361-8. https://doi.org/10.1111/ene.12483.
Laureys S, Celesia GG, Cohadon F, Lavrijsen J, Leon-Carrion J, Sannita WG, et al. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med. 2010;8:68. https://doi.org/10.1186/1741-7015-8-68.
Monti MM, Laureys S, Owen AM. The vegetative state. BMJ. 2010;341:c3765. https://doi.org/10.1136/bmj.c3765.
Giacino JT, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, et al. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002;59(9):1473-4.
Bruno MA, Vanhaudenhuyse A, Thibaut A, Moonen G, Laureys S. From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness. J Neurol. 2011;258(7):1373-84. https://doi.org/10.1007/s00415-011-6114-x.
Gosseries O, Zasler ND, Laureys S. Recent advances in disorders of consciousness: focus on the diagnosis. Brain Inj. 2014;28(9):1141-50. https://doi.org/10.3109/02699052.2014.920522.
Hirschberg R, Giacino JT. The vegetative and minimally conscious states: diagnosis, prognosis and treatment. Neurol Clin. 2011;29(4):773-86. https://doi.org/10.1016/j.ncl.2011.07.009.
Gosseries O, Di H, Laureys S, Boly M. Measuring consciousness in severely damaged brains. Annu Rev Neurosci. 2014;37:457-78. https://doi.org/10.1146/annurev-neuro-062012-170339.
Ashwal S, Cranford R. Medical aspects of the persistent vegetative state - a correction. The multi-society task force on PVS. N Engl J Med. 1995;333(2):130. https://doi.org/10.1056/NEJM199507133330217.
Giacino JT, Katz DI, Schiff ND, Whyte J, Ashman EJ, Ashwal S, et al. Comprehensive systematic review update summary: disorders of consciousness: report of the guideline development, dissemination, and implementation Subcommittee of the American Academy of neurology; the American congress of rehabilitation medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology. 2018;91(10):461-70. https://doi.org/10.1212/WNL.0000000000005928.
Giacino JT. The vegetative and minimally conscious states: consensus-based criteria for establishing diagnosis and prognosis. NeuroRehabilitation. 2004;19(4):293-8.
Machado C, Perez-Nellar J, Rodriguez R, Scherle C, Korein J. Emergence from minimally conscious state: insights from evaluation of posttraumatic confusion. Neurology. 2010;74(14):1156-7. https://doi.org/10.1212/WNL.0b013e3181d5df0d.
Nakase-Richardson R, Yablon SA, Sherer M, Evans CC, Nick TG. Serial yes/no reliability after traumatic brain injury: implications regarding the operational criteria for emergence from the minimally conscious state. J Neurol Neurosurg Psychiatry. 2008;79(2):216-8. https://doi.org/10.1136/jnnp.2007.127795.
Childs NL, Mercer WN, Childs HW. Accuracy of diagnosis of persistent vegetative state. Neurology. 1993;43(8):1465-7.
Andrews K. Medical decision making in the vegetative state: withdrawal of nutrition and hydration. NeuroRehabilitation. 2004;19(4):299-304.
Fins JJ, Bernat JL. Ethical, palliative, and policy considerations in disorders of consciousness. Neurology. 2018;91(10):471-5. https://doi.org/10.1212/WNL.0000000000005927.
Thibaut A, Bruno MA, Ledoux D, Demertzi A, Laureys S. tDCS in patients with disorders of consciousness: sham-controlled randomized double-blind study. Neurology. 2014;82(13):1112-8. https://doi.org/10.1212/WNL.0000000000000260.
Boly M, Faymonville ME, Schnakers C, Peigneux P, Lambermont B, Phillips C, et al. Perception of pain in the minimally conscious state with PET activation: an observational study. Lancet Neurol. 2008;7(11):1013-20. https://doi.org/10.1016/S1474-4422(08)70219-9.
Giacino JT, Kalmar K, Whyte J. The JFK coma recovery scale-revised: measurement characteristics and diagnostic utility. Arch Phys Med Rehabil. 2004;85(12):2020-9. https://doi.org/10.1016/j.apmr.2004.02.033.
Giacino JT, Schnakers C, Rodriguez-Moreno D, Kalmar K, Schiff N, Hirsch J. Behavioral assessment in patients with disorders of consciousness: gold standard or fool's gold? Prog Brain Res. 2009;177:33-48. https://doi.org/10.1016/S0079-6123(09)17704-X.
Schnakers C, Vanhaudenhuyse A, Giacino J, Ventura M, Boly M, Majerus S, et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009;9(1):35. https://doi.org/10.1186/1471-2377-9-35.
Stender J, Gosseries O, Bruno M-A, Charland-Verville V, Vanhaudenhuyse A, Demertzi A, et al. Diagnostic precision of PET imaging and functional MRI in disorders of consciousness: a clinical validation study. Lancet. 2014;384(9942):514-22. https://doi.org/10.1016/s0140-6736(14)60042-8.
Zhang Y, Wang J, Schnakers C, He M, Luo H, Cheng L, et al. Validation of the Chinese version of the coma recovery scale-revised (CRS-R). Brain Inj. 2019;33(4):529-33. https://doi.org/10.1080/02699052.2019.1566832.
Di H, He M, Zhang Y, Cheng L, Wang F, Nie Y, et al. Chinese translation of the coma recovery scale-revised. Brain Inj. 2017;31(3):363-5. https://doi.org/10.1080/02699052.2016.1255780.
Binder M, Gorska U, Wojcik-Krzemien A, Gociewicz K. A validation of the polish version of the coma recovery scale-revised (CRSR). Brain Inj. 2018;32(2):242-6. https://doi.org/10.1080/02699052.2017.1406991.
Tamashiro M, Rivas ME, Ron M, Salierno F, Dalera M, Olmos L. A Spanish validation of the coma recovery scale-revised (CRS-R). Brain Inj. 2014;28(13-14):1744-7. https://doi.org/10.3109/02699052.2014.947621.
Mochalova E, Legostaeva L, Zimin A, Sergeev D, Domashenko M, Samorukov V, et al. A Russian validation study of the coma recovery scale-revised (CRS-R); 2018. https://doi.org/10.1101/276881.
Cortese MD, Riganello F, Arcuri F, Pugliese ME, Lucca LF, Dolce G, et al. Coma recovery scale-r: variability in the disorder of consciousness. BMC Neurol. 2015;15:186. https://doi.org/10.1186/s12883-015-0455-5.
Schnakers C. Clinical assessment of patients with disorders of consciousness. Arch Ital Biol. 2012;150(2-3):36-43.
Kotchoubey B, Vogel D, Lang S, Muller F. What kind of consciousness is minimal? Brain Inj. 2014;28(9):1156-63. https://doi.org/10.3109/02699052.2014.920523.
Wannez S, Heine L, Thonnard M, Gosseries O, Laureys S. Coma science group c: the repetition of behavioral assessments in diagnosis of disorders of consciousness. Ann Neurol. 2017;81(6):883-9. https://doi.org/10.1002/ana.24962.
Sun Y, Wang J, Heine L, Huang W, Wang J, Hu N, et al. Personalized objects can optimize the diagnosis of EMCS in the assessment of functional object use in the CRS-R: a double blind, randomized clinical trial. BMC Neurol. 2018;18(1):38. https://doi.org/10.1186/s12883-018-1040-5.
Stenberg J, Godbolt AK, Moller MC. The value of incorporating personally relevant stimuli into consciousness assessment with the coma recovery scale - revised: a pilot study. J Rehabil Med. 2018;50(3):253. https://doi.org/10.2340/16501977-2309.
Giacino JT, Katz DI, Schiff ND, Whyte J, Ashman EJ, Ashwal S, et al. Practice guideline update recommendations summary: disorders of consciousness: report of the guideline development, dissemination, and implementation Subcommittee of the American Academy of neurology; the American congress of rehabilitation medicine; and the National Institute on Disability, Independent Living, and Rehabilitation Research. Neurology. 2018;91(10):450-60. https://doi.org/10.1212/WNL.0000000000005926.
Bodien YG, Carlowicz CA, Chatelle C, Giacino JT. Sensitivity and specificity of the coma recovery scale - revised Total score in detection of conscious awareness. Arch Phys Med Rehabil. 2016;97(3):490-2e1. https://doi.org/10.1016/j.apmr.2015.08.422.
Schnakers C, Majerus S, Giacino J, Vanhaudenhuyse A, Bruno MA, Boly M, et al. A French validation study of the coma recovery scale-revised (CRS-R). Brain Inj. 2008;22(10):786-92. https://doi.org/10.1080/02699050802403557.
Cheng L, Gosseries O, Ying L, Hu X, Yu D, Gao H, et al. Assessment of localisation to auditory stimulation in post-comatose states: use the patient's own name. BMC Neurol. 2013;13:27. https://doi.org/10.1186/1471-2377-13-27.
Vanhaudenhuyse A, Schnakers C, Bredart S, Laureys S. Assessment of visual pursuit in post-comatose states: use a mirror. J Neurol Neurosur Ps. 2008;79(2):223. https://doi.org/10.1136/Jnnp.2007.121624.
Wannez S, Vanhaudenhuyse A, Laureys S, Bredart S. Mirror efficiency in the assessment of visual pursuit in patients in minimally conscious state. Brain Inj. 2017;31(11):1429-35. https://doi.org/10.1080/02699052.2017.1376755.
Wannez S, Gosseries O, Azzolini D, Martial C, Cassol H, Aubinet C, et al. Prevalence of coma-recovery scale-revised signs of consciousness in patients in minimally conscious state. Neuropsychol Rehabil. 2017;28(8):1350. https://doi.org/10.1080/09602011.2017.1310656.