A French validation study of the Coma Recovery Scale-Revised (CRS-R)

Abstract

Primary objective: The aim of the present study was to explore the concurrent validity, inter-rater agreement and diagnostic sensitivity of a French adaptation of the Coma Recovery Scale-Revised (CRS-R) as compared to other coma scales such as the Glasgow Coma Scale (GCS), the Full Outline of UnResponsiveness scale (FOUR) and the Wessex Head Injury Matrix (WHIM). Research design: Multi-centric prospective study. Method and procedures: To test concurrent validity and diagnostic sensitivity, the four behavioural scales were administered in a randomized order in 77 vegetative and minimally conscious patients. Twenty-four clinicians with different professional backgrounds, levels of expertise and CRS-R experience were recruited to assess inter-rater agreement. Main outcomes and results: Good concurrent validity was obtained between the CRS-R and the three other standardized behavioural scales. Inter-rater reliability for the CRS-R total score and sub-scores was good, indicating that the scale yields reproducible findings across examiners and does not appear to be systematically biased by profession, level of expertise or CRS-R experience. Finally, the CRS-R demonstrated a significantly higher sensitivity to detect MCS patients, as compared to the GCS, the FOUR and the WHIM. Conclusion:The results show that the French version of the CRS-R is a valid and sensitive scale which can be used in severely brain damaged patients by all members of the medical staff.

A multicentre study of intentional behavioural responses measured using the Coma Recovery Scale–Revised in patients with minimally conscious state

“…For this reason, the present findings do not suggest use of the visual subscale as the only tool for detection of non-reflexive behaviour, but they underline the importance of accurate administration of the visual subscale, particularly if one considers that in 14/52 patients of the present sample only the visual subscale could detect signs of consciousness (i.e, visual pursuit and sustained visual fixation). Similar considerations apply to the motor subscale, that was the second most sensitive subscale (with a detection rate slightly higher than that reported in the French validation study 8 ) and that was the only subscale to detect signs of non-reflexive behaviour in 4/52 patients of the present sample (i.e., localization of noxious stimulation and object manipulation), whereas the remaining subscales could identify a lower percentage of patients in a minimally conscious state, and did so only in presence of non-reflexive behaviours on the visual and/or the motor subscale.…”

Validation of the Italian version of the Coma Recovery Scale-Revised (CRS-R)

“…The scale expressly incorporates diagnostic criteria for VS, MCS and the emergence from MCS (MCSþ), allowing the examiner to make a diagnosis based directly on bedside behavioural observations. The scale was shown to have adequate reliability and validity [13][14][15]. French [14] and Norwegian [15] versions of the scale are already available, while Italian-speaking health professionals are faced with the lack of a validated scale in their own language.…”

Probing consciousness with event-related potentials in the vegetative state

“…5 It was carried out after careful neurologic examination by trained neurologists (F.F., L.N. ), immediately before ERP recording.…”