Score on Coma Recovery Scale-Revised at admission predicts outcome at discharge in intensive rehabilitation after severe brain injury

Portaccio, Emilio; Morrocchesi, Azzurra; Romoli, Anna Maria; Hakiki, Bahia; Taglioli, Maria Pia; Lippi, Elena; Renzone, Martina Di; Grippo, Antonello; Macchi, Claudio

doi:10.1080/02699052.2018.1440420

Cited by 47 publications

(30 citation statements)

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“…38,[41][42][43][44] Besides these demographic and anamnestic indicators of better outcome, we found a significant role of the CRS-R total score in predicting better clinical evolution. The present findings supported the prognostic validity of CRS-R total score, in keeping with previous short-term 11 and long-term 10,45 longitudinal studies on individuals with DoC. Moreover, it is important to emphasize that age, time from injury, and CRS-R total score remained significant outcome predictors after accounting for covariates such as clinical diagnosis, etiology of brain injury, and functional disability level, which were considered significant outcome predictors in previous studies.…”

Section: Discussionsupporting

confidence: 91%

“…[33][34][35][36] Utilizing logistic regression analysis, we observed that younger age and shorter time since brain injury were significant predictors of a better outcome. Many previous studies 1,10,11,[36][37][38] found that older age was associated with a lower likelihood of recovery, likely due to lower age-related brain plasticity 39 and worse general premorbid health conditions. 40 The significant effect of time from injury at baseline is potentially related to the fact that patients with more severe brain injuries are usually admitted later to the rehabilitation settings in which the large majority of the present sample was enrolled.…”

Section: Discussionmentioning

confidence: 97%

“…This procedure was conducted independently of patients' language comprehension abilities on the behavioral examination. 25 EEG activity was continuously recorded (band pass filtered at 0.1-100 Hz; digitized at a sampling rate of 1,024 Hz) from at least 3 (Fz, Cz, and Pz) scalp electrodes (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) International System) all referred to linked earlobes, with the ground electrode positioned on Fpz. In the presence of a N100, detection of late cortical component P300 was evaluated by visual identification by a trained neurophysiologist based on latency (280-500 ms) and scalp topography central to parietal (80-150 ms).…”

Section: Neurophysiologic Examinationmentioning

confidence: 99%

“…8,9 A recent study examined the prognostic value of SEPs in anoxic VS/UWS at 1-3 months after brain injury, 10 confirming their utility in the rehabilitative setting. Recent longitudinal studies demonstrated the prognostic value of the Coma Recovery Scale-Revised (CRS-R) 10,11 and of EEG background activity 12,13 in the subacute phase. However, the majority of these prognostic studies evaluated individual clinical or neurophysiologic predictors, an approach that precludes identification of the independent predictive role of each biomarker.…”

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confidence: 99%

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Multicenter prospective study on predictors of short-term outcome in disorders of consciousness

et al. 2020

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Objective.This international multi-center, prospective, observational study aimed at identifying predictors of short-term clinical outcome in patients with prolonged Disorders of Consciousness (DoC) due to acquired severe brain injury.Methods.Patients in vegetative state/unresponsive wakefulness syndrome (VS/UWS) or in minimally conscious state (MCS) were enrolled within 3 months from their brain injury in 12 specialized medical institutions. Demographic, anamnestic, clinical and neurophysiological data were collected at study entry. Patients were then followed-up for assessing the primary outcome, i.e. clinical diagnosis according to standardized criteria at 6 months post-injury.Results.We enrolled 147 patients (44 women; mean age: 49.4 [95% confidence intervals: 46.1-52.6] years; VS/UWS= 71, MCS= 76; traumatic= 55, vascular= 56, anoxic= 36; mean time post-injury= 59.6 [55.4-63.6] days). The 6-month follow-up was complete for 143 patients (VS/UWS= 70; MCS= 73). With respect to study entry, the clinical diagnosis improved in 72 patients (VS/UWS= 27; MCS= 45). Younger age, shorter time post-injury, higher Coma Recovery Scale-Revised total score and presence of EEG reactivity to eye opening at study entry predicted better outcome, whereas etiology, clinical diagnosis, Disability Rating Scale score, EEG background activity, acoustic reactivity and P300 on event related potentials were not associated with outcome.Conclusions.Multimodal assessment could identify patients with higher likelihood of clinical improvement in order to help clinicians, families and funding sources with various aspects of decision-making. This multi-center, international study aims to stimulate further research that drives international consensus regarding standardization of prognostic procedures for patients with DoC.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Section: Neurophysiologic Examinationmentioning

confidence: 99%

mentioning

confidence: 99%

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Multicenter prospective study on predictors of short-term outcome in disorders of consciousness

et al. 2020

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“…Only recently has the need for specific biomarkers, which could assist in defining long-term functional prognosis [2,4,[11][12][13] rather than just survival, being highlighted.…”

Section: Introductionmentioning

confidence: 99%

Developing an instrument for an early prediction model of long-term functional outcomes in people with acquired injuries of the central nervous system: protocol and methodological aspects

et al. 2020

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Severe acquired brain injury (ABI) is a major cause of long-term disability and is the main determinant of health and societal costs. Early identification of favourable long-term recovery would allow personalized rehabilitative programs and better health care resources allocation. In light of the higher survival rate from intensive care units (ICU) in recent years, there is a growing need for early prognostication markers of functional recovery; to date, these data have been mainly collected at rehabilitation unit admission and not during the acute phase. We present the protocol and methodology to develop prediction models in people with severe acquired brain injury (GCS at admission to ICU < 8) for the functional and cognitive outcome at 12 months from the event. Predictors will be collected during the acute stage. Participants will be recruited within the first 72 h from the event in the ICUs of two teaching hospitals (Padova and Treviso). Participants will be followed up at discharge from ICU, admission and discharge from Neurorehabilitation and after 12 months from the event. Clinical and functional scales, electroencephalography, evoked potentials, magnetic resonance imaging and serological markers will be entered into a digital registry. Survival will be estimated using the Cox proportional hazard model. A multivariate prediction model will be developed for each of the functional and cognitive outcomes at 12 months from the event.

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Predicting outcome in disorders of consciousness: A mega‐analysis

Pavlov,

Spiegelsberger,

Kotchoubey

2024

Ann Clin Transl Neurol

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ObjectiveAssessing recovery potential in patients with disorders of consciousness (DoC) is pivotal for guiding clinical and ethical decisions. We conducted a mega‐analysis of individual patient data to understand (1) if a time threshold exists, beyond which regaining consciousness is almost impossible, and (2) how recovery varies based on factors such as diagnosis, etiology, age, sex, and neuropsychological status.MethodsA systematic literature search revealed a total of 3290 patients. In this sample, we performed a Cox proportional hazards analysis for interval censored data.ResultsWe observed a late saturation of probability to regain consciousness in Kaplan–Meier curves, and the annual rate of recovery was remarkably stable, in that approximately 35% of patients regained consciousness per year. Patients in minimally conscious state (MCS) recovered more frequently than patients in unresponsive wakefulness syndrome (UWS). No significant difference was observed between the recovery dynamics of MCS subgroups: MCS+ and MCS−. Patients with hypoxic brain lesions showed worse recovery rate than patients with traumatic brain injury and patients with vascular brain lesions, while the latter two categories did not differ from each other. Male patients had moderately better chance to regain consciousness. While younger UWS patients recovered more frequently than older patients, it was not the case in MCS.InterpretationOur findings highlight the necessity for neurologists to exercise caution when making negative predictions in individual cases, challenge traditional beliefs regarding recovery timelines, and underscore the importance of conducting detailed and prolonged assessments to better understand recovery prospects in DoC.

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Score on Coma Recovery Scale-Revised at admission predicts outcome at discharge in intensive rehabilitation after severe brain injury

Abstract: Higher CRS-R scores at admission in intensive rehabilitation unit can help differentiate patients with better outcome at discharge, providing information for rehabilitation planning and communication with patients and their caregivers.

Cited by 47 publications

References 32 publications

Multicenter prospective study on predictors of short-term outcome in disorders of consciousness

Multicenter prospective study on predictors of short-term outcome in disorders of consciousness

Developing an instrument for an early prediction model of long-term functional outcomes in people with acquired injuries of the central nervous system: protocol and methodological aspects

Predicting outcome in disorders of consciousness: A mega‐analysis

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