Sensitivity and Specificity of the Coma Recovery Scale-Revised Total Score in Detection of Conscious Awareness
Sensitivity and Specificity of the Coma Recovery Scale-Revised Total Score in Detection of Conscious Awareness
复制标题
DOI：
10.1016/j.apmr.2015.08.422
复制
发表时间：
2016-03-01
影响因子：
4.3
通讯作者：
Giacino, Joseph T.
中科院分区：
文献类型：
--
作者：
Bodien, Yelena G.;Carlowicz, Cecilia A.;Giacino, Joseph T.
目的：探讨昏迷恢复量表修订版(CRS-R)总分在检测意识觉醒中的敏感性和特异性。设计：对参加意识障碍专科治疗的患者的病历资料进行回顾性分析。以CRS-R诊断的最低意识状态(MCS)或从最低意识状态(EMCS)中出现作为意识意识的参考标准，以CRS-R总分为测试标准，完成敏感性和特异性分析。设置：专业DOC项目。参与者：参加DOC项目的患者(N=252,157名男性；平均年龄，49岁；平均受伤时间，48天；创伤病因，n=127；非创伤病因，n=125；昏迷或植物状态诊断，n=70；主要观察指标：CRS-R总分检测意识觉醒的敏感度和特异度。结果：CRS-R总分在10分或更高时，正确识别MCS或EMCS患者的敏感度为0.78，正确识别不符合这两种诊断标准的患者(即被诊断为植物人状态或昏迷)的特异度为1.00。受试者工作特征曲线分析中的曲线下面积为0.98。结论：CRS-R总分为10分或更高提供了意识觉醒的有力证据，但根据CRS-R诊断标准显示有意识的患者中，有22%的患者出现假阴性诊断错误。8分的临界值提供了灵敏度和特异度之间的最佳平衡，准确地对93%的病例进行了分类。根据用户的目标，最佳总分截止值会有所不同。(C)2016年度美国康复医学大会
Objective: To describe the sensitivity and specificity of Coma Recovery Scale-Revised (CRS-R) total scores in detecting conscious awareness.Design: Data were retrospectively extracted from the medical records of patients enrolled in a specialized disorders of consciousness (DOC) program. Sensitivity and specificity analyses were completed using CRS-R derived diagnoses of minimally conscious state (MCS) or emerged from minimally conscious state (EMCS) as the reference standard for conscious awareness and the total CRS-R score as the test criterion. A receiver operating characteristic curve was constructed to demonstrate the optimal CRS-R total cutoff score for maximizing sensitivity and specificity.Setting: Specialized DOC program.Participants: Patients enrolled in the DOC program (N=252, 157 men; mean age, 49y; mean time from injury, 48d; traumatic etiology, n=127; nontraumatic etiology, n=125; diagnosis of coma or vegetative state, n=70; diagnosis of MCS or EMCS, n=182).Interventions: Not applicable.Main Outcome Measures: Sensitivity and specificity of CRS-R total scores in detecting conscious awareness.Results: A CRS-R total score of 10 or higher yielded a sensitivity of .78 for correct identification of patients in MCS or EMCS, and a specificity of 1.00 for correct identification of patients who did not meet criteria for either of these diagnoses (ie, were diagnosed with vegetative state or coma). The area under the curve in the receiver operating characteristic curve analysis is .98.Conclusions: A total CRS-R score of 10 or higher provides strong evidence of conscious awareness but resulted in a false-negative diagnostic error in 22% of patients who demonstrated conscious awareness based on CRS-R diagnostic criteria. A cutoff score of 8 provides the best balance between sensitivity and specificity, accurately classifying 93% of cases. The optimal total score cutoff will vary depending on the user's objective. (C) 2016 by the American Congress of Rehabilitation Medicine