Joint Neuropsychological Assessment through Coma/Near Coma and Level of Cognitive Functioning Assessment Scales Reduces Negative Findings in Pediatric Disorders of Consciousness

Abstract

The present study aimed to: (a) characterize the emergence to a conscious state (CS) in a sample of children and adolescents with severe brain injury during the post-acute rehabilitation and through two different neuropsychological assessment tools: the Rappaport Coma/Near Coma Scale (CNCS) and Level of Cognitive Functioning Assessment Scale (LOCFAS); (b) compare the evolution in patients with brain lesions due to traumatic and non-traumatic etiologies; and (c) describe the relationship between the emergence to a CS and some relevant clinical variables. In this observational prospective longitudinal study, 92 consecutive patients were recruited. Inclusion criteria were severe disorders of consciousness (DOC), Glasgow Coma Scale (GCS) score ≤8 at insult, age 0 to 18 years, and direct admission to inpatient rehabilitation from acute care. The main outcome measures were CNCS and LOCFAS, both administered three and six months after injury. The cohort globally shifted towards milder DOC over time, moving from overall ‘moderate/near coma’ at three months to ‘near/no coma’ at six months post-injury. The shift was captured by both CNCS and LOCFAS. CNCS differentiated levels of coma at best, while LOCFAS was superior in characterizing the emergence from coma. Agreement between scales was fair, and reduced negative findings at less than 10%. Patients with traumatic brain injury (TBI) vs. non-traumatic brain injury (NTBI) were older and had neurosurgical intervention more frequently. No relation between age and the level of consciousness was found overall. Concurrent administration of CNCS and LOCFAS reduced the rate of false negatives and better detected signs of arousal and awareness. This provides indication to administer both tools to increase measurement precision.

Individualized Prognostic Prediction of the Long-Term Functional Trajectory in Pediatric Acquired Brain Injury

“…However, top- and bottom-scale saturations affect the recovery rates of high-start fast responders and non-responders in this study. Assessment through scales for disorder of consciousness should be applied to the latter group [ 38 ].…”

EEG Assessment in a 2-Year-Old Child with Prolonged Disorders of Consciousness: 3 Years’ Follow-up

“…The scope of the behavior scale used (the pediatric GCS) is restricted to young children. The Rappaport Coma/Near Coma Scale (CNCS) and Level of Cognitive Functioning Assessment Scale (LOCFAS) [ 48 ] may be considered in future studies; however, both these scales are currently used less often and it will take time for clinicians to become familiar with their use. Multimodality assessments, combined with brain imaging, may provide a more advantageous measure.…”

Emerging Treatments for Disorders of Consciousness in Paediatric Age

“…Traumatic brain injury (TBI) is still one of the leading causes of paediatric DoC (~47.8% [ 10 ]). Although TBI is declining in Europe and North America [ 11 , 12 , 13 ], low- and low-middle-income countries (LMICs) see a worrying increase due to growing motorisation, affecting especially children in South Asia and the West Pacific [ 14 , 15 , 16 ].…”

“…As the causes of DoC are variegated, and the disability often severe and prolonged, the treatment course and outcome are highly variable. The assessment of consciousness must be performed through standard tools, specifically validated or adapted for paediatrics (i.e., CNCS, LOCFAS, and PALOC instruments) [ 10 , 19 ]. Of note, the Coma Recovery Scale—Revised (CRS-R) [ 20 ], which is the standard in adults, has been increasingly used in paediatric research (e.g., [ 21 , 22 , 23 , 24 ]), but, to date, it has only been tested in healthy children, and not yet in children with DoC [ 25 ].…”