[en] Establishing an accurate diagnosis is crucial for patients with disorders of consciousness (DoC) following a severe brain injury. The Coma Recovery Scale-Revised (CRS-R) is the recommended behavioral scale for assessing the level of consciousness among these patients, but its long administration duration is a major hurdle in clinical settings. The Simplified Evaluation of CONsciousness Disorders (SECONDs) is a shorter scale that was developed to tackle this issue. It consists of six mandatory items, observation, command-following, visual pursuit, visual fixation, oriented behaviors, and arousal, and two conditional items, communication and localization to pain. The score ranges between 0 and 8 and corresponds to a specific diagnosis (i.e., coma, unresponsive wakefulness syndrome, minimally conscious state minus/plus, or emergence from the minimally conscious state). A first validation study on patients with prolonged DoC showed high concurrent validity and intra- and inter-rater reliability. The SECONDs requires less training than the CRS-R and its administration lasts about 7 minutes (interquartile range: 5-9 minutes). An additional index score allows the more precise tracking of a patient’s behavioral fluctuation or evolution over time. The SECONDs is therefore a fast and valid tool for assessing the level of consciousness in patients with severe brain injury. It can easily be used by healthcare staff and implemented in time-constrained clinical settings, such as intensive care units, to help decrease misdiagnosis rates and to optimize treatment decisions. These administration guidelines provide detailed
instructions for administering the SECONDs in a standardized and reproducible manner, which is
an essential requirement for achieving a reliable diagnosis.
Research center :
Giga Consciousness-Coma Science Group ; CHU de Liège - Centre du Cerveau²
Disciplines :
Neurology
Author, co-author :
Sanz, Leandro ✱; Université de Liège - ULiège > Consciousness-Coma Science Group
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
Laureys, S., Owen, A.M., Schiff, N.D. Brain function in coma, vegetative state, and related disorders. Lancet Neurology. 3 (9), 537–546 (2004).
Laureys, S. et al. Unresponsive wakefulness syndrome: A new name for the vegetative state or apallic syndrome. BMC Medicine. 8, 2–5 (2010).
The Multy-Society Task Force on PVS Medical aspects of the persistent vegetative state (2). The New England Journal of Medicine. 330 (22), 1499–1508 (1994).
Giacino, J.T., et al. The minimally conscious state. Neurology. 58 (3), 349–353 (2002).
Bruno, M.-A.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. Journal of Neurology. 258 (7), 1373–1384 (2011).
Bruno, M.A., Laureys, S., Demertzi, A. Coma and disorders of consciousness. Handbook of Clinical Neurology. 118, 205–213 (2013).
Thibaut, A., Bruno, M.-A., Ledoux, D., Demertzi, A., Laureys, S. tDCS in patients with disorders of consciousness Sham-controlled randomized doubleblind study. Neurology. 82 (13), 1112–1118 (2014).
Chatelle, C. et al. Is the Nociception Coma Scale-revised a Useful Clinical Tool for Managing Pain in Patients With Disorders of Consciousness? The Clinical Journal of Pain. 32 (4), 321–326 (2016).
Estraneo, A. et al. Multi-center prospective study on predictors of short-term outcome in disorders of consciousness. Neurology. (2020).
Demertzi, A. et al. Attitudes towards end-of-life issues in disorders of consciousness: A European survey. Journal of Neurology. 258 (6), 1058–1065 (2011).
Andrews, K., Murphy, L., Munday, R., Littlewood, C. Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit. The BMJ (Clinical research ed.). 313 (7048), 13–6 (1996).
Childs, N.L., Mercer, W.N., Childs, H.W. Accuracy of diagnosis of persistent vegetative state. Neurology. 43 (8), 1465–7 (1993).
Gill-Thwaites, H. Lotteries, loopholes and luck: misdiagnosis in the vegetative state patient. Brain injury. 20 (13–14), 1321–8 (2006).
van Erp, W.S., et al. The Vegetative State: Prevalence, Misdiagnosis, and Treatment Limitations. Journal of the American Medical Directors Association. 16 (1), 85.e9-85.e14 (2015).
Schnakers, C. et al. Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment. 5, 1–5 (2009).
Giacino, J.T., Kalmar, K., Whyte, J. The JFK Coma Recovery Scale-Revised: Measurement characteristics and diagnostic utility. Archives of Physical Medicine and Rehabilitation. 85 (12), 2020–2029 (2004).
Seel, R.T. et al. Assessment scales for disorders of consciousness: Evidence-based recommendations for clinical practice and research. Archives of Physical Medicine and Rehabilitation. 91 (12), 1795–1813 (2010).
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. Archives of Physical Medicine and Rehabilitation. 97 (3), 490–492 (2016).
Chatelle, C. et al. Detection and Interpretation of Impossible and Improbable Coma Recovery Scale Revised Scores. Archives of Physical Medicine and Rehabilitation. 97 (8), 1295-1300.e4 (2016).
Annen, J. et al. Diagnostic accuracy of the CRS-R index in patients with disorders of consciousness. Brain Injury. 33 (11), 1409–1412 (2019).
Wannez, S., Heine, L., Thonnard, M., Gosseries, O., Laureys, S. The repetition of behavioral assessments in diagnosis of disorders of consciousness. Annals of Neurology. 81 (6), 883–889 (2017).
Aubinet, C. et al. Simplified Evaluation of CONsciousness Disorders (SECONDs) in individuals with severe brain injury: a validation study. Annals of physical and rehabilitation medicine. 1–31 (2020).
Wannez, S. et al. Prevalence of coma-recovery scalerevised signs of consciousness in patients in minimally conscious state. Neuropsychological Rehabilitation. 2011, 1–10 (2017).
Løvstad, M., et al. Reliability and diagnostic characteristics of the JFK Coma Recovery Scale Revised: Exploring the influence of raters level of experience. Journal of Head Trauma Rehabilitation. 25 (5), 349–356 (2010).
Gosseries, O., Zasler, N.D., Laureys, S. Recent advances in disorders of consciousness: Focus on the diagnosis. Brain Injury. 28 (9), 1141–1150 (2014).
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 (14), 1120–1126 (2009).
Wannez, S. et al. Objective assessment of visual pursuit in patients with disorders of consciousness: an exploratory study. Journal of Neurology. 264 (5), 928– 937 (2017).
Teasdale, G., Jennett, B. Assessment of coma and impaired consciousness. The Lancet. 304 (7872), 81–84 (1974).
Rappaport, M., Dougherty, A.M., Kelting, D.L. Evaluation of coma and vegetative states. Archives of Physical Medicine and Rehabilitation. 73 (7), 628–34 (1992).
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. Annals of Neurology. 58 (4), 585–593 (2005).
Born, J.D., Albert, A., Hans, P., Bonnal, J. Relative Prognostic Value of Best Motor Response and Brain Stem Reflexes in Patients with Severe Head Injury. Neurosurgery. 16 (5), 595–601 (1985).
Giacino, J.T. et al. Practice guideline update recommendations summary: Disorders of consciousness. Neurology. 91 (10), 450–460 (2018).
Portaccio, E. et al. Improvement on the Coma Recovery Scale–Revised During the First Four Weeks of Hospital Stay Predicts Outcome at Discharge in Intensive Rehabilitation After Severe Brain Injury. Archives of Physical Medicine and Rehabilitation. 99 (5), 914–919 (2018).
