Outcome prediction in disorders of consciousness: the role of coma recovery scale revised
Abstract Background: To evaluate the utility of the revised coma remission scale (CRS-r), together with other clinical variables, in predicting emergence from a disorder of consciousness (DoC) after intensive rehabilitation care. Method: This is a prospective observational cohort study of consecutive 180 brain-injured patients with prolonged DoC upon admission to neurorehabilitation unit. 123 patients in a vegetative state (VS) and 57 in a minimally conscious state (MCS) were included and followed for a period of 8 weeks in the intensive care unit (ICU). Demographical and clinical factors were used as outcome measures. Univariate and multivariate Cox regression models were employed for examining potential predictors for clinical outcome along the time. Results: VS and MCS groups were matched for demographical and clinical (i.e., aetiology, tracheostomy and feed administration) variables. Within 2 months after admission in intensive neurorehabilitation unit, 3.9% were dead, 35.5% had a full recovery of consciousness and 111 66.7% remained in VS or MCS. Multivariate analysis demonstrated that the best predictor of functional improvement were the CRS-r scores. In particular, patients with values greater than 12 at admission were those with favorable likelihood of emergence from DoC. Conclusions: Our study highlights the role of the CRS-r scores for predicting short-term favorable outcome.