Feasibility and Validity of the Coma Recovery Scale-Revised for Accelerated Standardized Testing: A Practical Assessment Tool for Detecting Consciousness in the Intensive Care Unit

Yelena G Bodien; Isha Vora; Alice Barra; Kevin Chiang; Camille Chatelle; Kelsey Goostrey; Geraldine Martens; Christopher Malone; Jennifer Mello; Kristin Parlman; Jessica Ranford; Ally Sterling; Abigail B Waters; Ronald Hirschberg; Douglas I Katz; Nicole Mazwi; Pengsheng Ni; George Velmahos; Karen Waak; Brian L Edlow; Joseph T Giacino

doi:10.1002/ana.26740

Feasibility and Validity of the Coma Recovery Scale-Revised for Accelerated Standardized Testing: A Practical Assessment Tool for Detecting Consciousness in the Intensive Care Unit

Ann Neurol. 2023 Nov;94(5):919-924. doi: 10.1002/ana.26740. Epub 2023 Aug 9.

Authors

Yelena G Bodien^{1

2}, Isha Vora³, Alice Barra^{1

4}, Kevin Chiang⁵, Camille Chatelle^{1

4}, Kelsey Goostrey¹, Geraldine Martens^{1

4

6}, Christopher Malone¹, Jennifer Mello⁷, Kristin Parlman⁸, Jessica Ranford⁹, Ally Sterling¹, Abigail B Waters^{1

10}, Ronald Hirschberg^{1

11}, Douglas I Katz^{12

13}, Nicole Mazwi^{1

11

14}, Pengsheng Ni¹⁵, George Velmahos⁵, Karen Waak⁸, Brian L Edlow^{2

16}, Joseph T Giacino^{1

17}

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, MA, USA.
² Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
³ Department of Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA.
⁴ Coma GIGA Science Group, University of Liege, Liege, Belgium.
⁵ Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
⁶ Department of Surgery, University of Montréal, Montréal, QC, Canada.
⁷ Department of Speech-language and Swallowing, Massachusetts General Hospital, Boston, MA, USA.
⁸ Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA.
⁹ Department of Occupational Therapy, Massachusetts General Hospital Boston, Boston, MA, USA.
¹⁰ Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
¹¹ Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
¹² Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
¹³ Encompass Health Braintree Rehabilitation, Braintree, MA, USA.
¹⁴ Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
¹⁵ Biostatistics & Epidemiology Data Analytic Center, Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
¹⁶ Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
¹⁷ Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

PMID: 37488068
PMCID: PMC10701693 (available on 2024-11-01)
DOI: 10.1002/ana.26740

Abstract

We developed and validated an abbreviated version of the Coma Recovery Scale-Revised (CRS-R), the CRS-R For Accelerated Standardized Testing (CRSR-FAST), to detect conscious awareness in patients with severe traumatic brain injury in the intensive care unit. In 45 consecutively enrolled patients, CRSR-FAST administration time was approximately one-third of the full-length CRS-R (mean [SD] 6.5 [3.3] vs 20.1 [7.2] minutes, p < 0.0001). Concurrent validity (simple kappa 0.68), test-retest (Mak's ρ = 0.76), and interrater (Mak's ρ = 0.91) reliability were substantial. Sensitivity, specificity, and accuracy for detecting consciousness were 81%, 89%, and 84%, respectively. The CRSR-FAST facilitates serial assessment of consciousness, which is essential for diagnostic and prognostic accuracy. ANN NEUROL 2023;94:919-924.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Coma* / diagnosis
Consciousness Disorders / diagnosis
Consciousness*
Feasibility Studies
Humans
Intensive Care Units
Recovery of Function
Reproducibility of Results

Abstract

Publication types

MeSH terms

Grants and funding