Coma recovery scale-r: variability in the disorder of consciousness.
Coma recovery scale-r: variability in the disorder of consciousness.
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DOI：
10.1186/s12883-015-0455-5
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发表时间：
2015-10-08
期刊：
影响因子：
2.6
通讯作者：
Sannita WG
中科院分区：
文献类型：
--
作者：
Cortese MD;Riganello F;Arcuri F;Pugliese ME;Lucca LF;Dolce G;Sannita WG
尽管有神经影像学研究的证据，植物人（VS/UWS）和最小意识（MCS）状态的诊断和早期预后仍然依赖于对反应性临床体征的观察。多项测试记录了一天中确定的反应性体征发生率的系统性变化。昏迷恢复量表修订版（CRS-r）评分的自发波动是可以想象的。我们回顾性分析了在常规13周内对7名VS/UWS和12名MCS受试者重复使用CRS-r进行系统观察。康复计划。在整个观察期间，VS/UWS和MCS亚组的CRS-r总体、视觉和听觉评分在上午高于下午给药时。VS/UWS受试者在13周内至少有一次晨间检查时被归类为MCS的概率。观察结果高达30%，即，这与两种临床状况之间报告的误诊率相符。建议进行多次CRS-r测试，以最大限度地减少错误分类的风险;自发变异性的估计可用于更准确地描述意识障碍患者的特征，并可能有助于优化康复计划。
Despite evidence from neuroimaging research, diagnosis and early prognosis in the vegetative (VS/UWS) and minimally conscious (MCS) states still depend on the observation of clinical signs of responsiveness. Multiple testing has documented a systematic variability during the day in the incidence of established signs of responsiveness. Spontaneous fluctuations of the Coma Recovery Scale-revised (CRS-r) scores are conceivable. We retrospectively analyzed the CRS-r repeatedly administered to 7 VS/UWS and 12 MCS subjects undergoing systematic observation during a conventional 13 weeks. rehabilitation plan. The CRS-r global, visual and auditory scores were found higher in the morning than at the afternoon administration in both VS/UWS and MCS subgroups over the entire period of observation. The probability for a VS/UWS subject of being classified as MCS at the morning testing at least once during the 13 weeks. observation was as high as 30 %, i.e., compatible with the reported misdiagnosis rate between the two clinical conditions. Multiple CRS-r testing is advisable to minimize the risk of misclassification; estimates of spontaneous variability could be used to characterize with greater accuracy patients with disorder of consciousness and possibly help optimize the rehabilitation plan.