Trauma; Coma; Rehabilitation; Disorders of consciousness
Abstract :
[en] Background
The Coma Recovery Scale-Revised (CRS-R) is the gold standard to assess severely brain-injured patients with prolonged disorders of consciousness (DoC). However, the amount of time needed to complete this examination may limit its use in clinical settings. Objective. We aimed to validate a new faster tool to assess consciousness in individuals with DoC.
Methods
This prospective validation study introduces the Simplified Evaluation of CONsciousness Disorders (SECONDs), a tool composed of 8 items: arousal, localization to pain, visual fixation, visual pursuit, oriented behaviors, command-following, and communication (both intentional and functional). A total of 57 individuals with DoC were assessed on 2 consecutive days by 3 blinded examiners: one CRS-R and one SECONDs were performed on 1 day, whereas 2 SECONDs were performed on the other day. A Mann-Whitney U test was used to compare the duration of administration of the SECONDs versus the CRS-R, and weighted Fleiss’ kappa coefficients were used to assess inter-/intra-rater reliability as well as concurrent validity.
Results
In the 57 participants, the SECONDs was about 2.5 times faster to administer than the CRS-R. The comparison of the CRS-R versus the SECONDs on the same day or the best of the 3 SECONDs led to “substantial” or “almost perfect” agreement (kappa coefficients ranging from 0.78 to 0.85). Intra-/inter-rater reliability also showed almost perfect agreement (kappa coefficients from 0.85 to 0.91 and 0.82 to 0.85, respectively).
Conclusions
The SECONDs appears to be a fast, reliable and easy-to-use scale to diagnose DoC and may be a good alternative to other scales in clinical settings where time constraints preclude a more thorough assessment.
Research center :
Giga Consciousness-Coma Science Group ; CHU de Liège - Centre du Cerveau²
Disciplines :
Neurology Neurology
Author, co-author :
Aubinet, Charlène ✱; Université de Liège - ULiège > Consciousness-Coma Science Group
Cassol, Helena ✱; Université de Liège - ULiège > Département d'aérospatiale et mécanique > Ingénierie des véhicules terrestres
BODART, Olivier ✱; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de neurologie
Sanz, Leandro ; Université de Liège - ULiège > Consciousness-Coma Science Group
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, 9, 2009, 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 384 (2014), 514–522.
van Erp, W.S., Lavrijsen, J.C.M., Vos, P.E., Bor, H., Laureys, S., Koopmans, R.T.C.M., The vegetative state: Prevalence, misdiagnosis, and treatment limitations. J Am Med Dir Assoc, 16, 2015 [85.e9-85.e14].
Thibaut, A., Bruno, M.A., Ledoux, D., Demertzi, A., Laureys, S., tDCS in patients with disorders of consciousness: Sham-controlled randomized double-blind study. Neurology 82 (2014), 1112–1118.
Chatelle, C., Val, M., De, Catano, A., Chaskis, C., Seeldrayers, P., et al. Is the Nociception Coma Scale-revised a Useful Clinical Tool for Managing Pain in Patients With Disorders of Consciousness?. Clin J Pain 32 (2016), 321–326.
Demertzi, A., Ledoux, D., Bruno, M.-A., Vanhaudenhuyse, A., Gosseries, O., Soddu, A., et al. Attitudes towards end-of-life issues in disorders of consciousness: a European survey. J Neurol 258 (2011), 1058–1065.
Giacino, J.T., Kalmar, K., Whyte, J., The JFK Coma Recovery Scale-Revised: Measurement characteristics and diagnostic utility. Arch Phys Med Rehabil 85 (2004), 2020–2029.
Bodien, Y.G., Carlowicz, C.A., Chatelle, C., Giacino, J.T., Sensitivity and Specificity of the Coma Recovery Scale–Revised Total Score in Detection of Conscious Awareness. Arch Phys Med Rehabil 97 (2016), 490–492.
Chatelle, C., Bodien, Y.G., Carlowicz, C., Wannez, S., Charland-Verville, V., Gosseries, O., et al. Detection and Interpretation of Impossible and Improbable Coma Recovery Scale-Revised Scores. Arch Phys Med Rehabil 97 (2016), 1295–1300 [.e4].
Annen, J., Filippini, M.M., Bonin, E., Cassol, H., Aubinet, C., Carrière, M., et al. Diagnostic accuracy of the CRS-R index in patients with disorders of consciousness. Brain Inj 33 (2019), 1409–1412.
Wannez, S., Heine, L., Thonnard, M., Gosseries, O., Laureys, S., The repetition of behavioral assessments in diagnosis of disorders of consciousness. Ann Neurol 81 (2017), 883–889.
Giacino, J.T., Katz, D.I., Schiff, N.D., Whyte, J., Ashman, E.J., Ashwal, S., et al. Practice guideline update recommendations summary: Disorders of consciousness. Neurology 91 (2018), 450–460.
Kondziella, D., Bender, A., Diserens, K., van Erp, W., Estraneo, A., Formisano, R., et al. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol, 2020, 1–16.
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, 1–10.
Wannez, S., Vanhaudenhuyse, A., Laureys, S., Brédart, S., Mirror efficiency in the assessment of visual pursuit in patients in minimally conscious state. Brain Inj 31 (2017), 1429–1435.
Wannez, S., Hoyoux, T., Langohr, T., Bodart, O., Martial, C., Wertz, J., et al. Objective assessment of visual pursuit in patients with disorders of consciousness: an exploratory study. J Neurol 264 (2017), 928–937.
Nakase-Richardson, R., Yablon, S.A., Sherer, M., Nick, T.G., Evans, C.C., Emergence from minimally conscious state: Insights from evaluation of posttraumatic confusion. Neurology 73 (2009), 1120–1126.
Wijdicks, E.F.M., Bamlet, W.R., Maramattom, B.V., Manno, E.M., McClelland, R.L., Validation of a new coma scale: The FOUR score. Ann Neurol 58 (2005), 585–593.
Schnakers, C., Majerus, S., Giacino, J., Vanhaudenhuyse, A., Bruno, M.-A., Boly, M., et al. A French validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Inj 22 (2008), 786–792.
Landis, J.R., Koch, G.G., The measurement of observer agreement for categorical data. Biometrics 33 (1977), 159–174.
Thibaut, A., Bodien, Y.G., Laureys, S., Giacino, J.T., Minimally conscious state “plus”: diagnostic criteria and relation to functional recovery. J Neurol, 2019.
Tooth, L.R., Ottenbacher, K.J., The κ statistic in rehabilitation research: An examination. Arch Phys Med Rehabil 85 (2004), 1371–1376.
Candelieri, A., Cortese, M.D., Dolce, G., Riganello, F., Sannita, W.G., Visual Pursuit: Within-Day Variability in the Severe Disorder of Consciousness. J Neurotrauma 28 (2011), 2013–2017.
Giacino, J.T., Ashwal, S., Childs, N., Cranford, R., Jennett, B., Katz, D.I., The minimally conscious state. Neurology 58 (2002), 349–353.
Nakase-Richardson, R., Yablon, S.A., Sherer, M., Evans, C.C., Nick, T.G., Serial yes/no reliability after traumatic brain injury: Implications regarding the operational criteria for emergence from the minimally conscious state. J Neurol Neurosurg Psychiatry 79 (2008), 216–218.
Teasdale, G., Jennett, B., Assessment of coma and impaired consciousness. Lancet 304 (1974), 81–84.
Overbeek, B.U.H., Eilander, H.J., Lavrijsen, J.C.M., Koopmans, R.T.C.M., Are visual functions diagnostic signs of the minimally conscious state? An integrative review. J Neurol 265 (2018), 1957–1975.
Lovstad, M., Froslie, K.F., Giacino, J.T., Skandsen, T., Anke, A., Schanke, A.K., Reliability and diagnostic characteristics of the JFK coma recovery scale-revised: exploring the influence of rater's level of experience. J Head Trauma Rehabil 25 (2010), 349–356.
Majerus, S., Bruno, M.A., Schnakers, C., Giacino, J.T., Laureys, S., The problem of aphasia in the assessment of consciousness in brain-damaged patients. Prog Brain Res 177 (2009), 49–61.
Schnakers, C., Bessou, H., Rubi-Fessen, I., Hartmann, A., Fink, G.R., Meister, I., et al. Impact of Aphasia on Consciousness Assessment: A Cross-Sectional Study. Neurorehabil Neural Repair 29 (2014), 41–47.
Edlow, B.L., Chatelle, C., Spencer, C.A., Chu, C.J., Bodien, Y.G., O'Connor, K.L., et al. Early detection of consciousness in patients with acute severe traumatic brain injury. Brain 140 (2017), 2399–2414.
Laureys, S., Celesia, G.G., Cohadon, F., Lavrijsen, J., León-Carrión, J., Sannita, W.G., et al. Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome. BMC Med, 8, 2010, 68.
Laureys, S., Boly, M., The changing spectrum of coma. Nat Clin Pract Neurol 4 (2008), 544–546.
Bruno, M.A., 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 258 (2011), 1373–1384.
