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

Abstract

Primary Objective: This study aims to validate the Chinese version of the Coma Recovery Scale-Revised (CRS-R). Methods: One hundred sixty-nine patients were assessed with both the CRS-R and the Glasgow Coma Scale (GCS), diagnosed as being in unresponsive wakefulness syndrome (UWS, formerly known as vegetative state), minimally conscious state (MCS), or emergence from MCS (EMCS). A subgroup of 50 patients has been assessed twice by the same rater, within 24 h. Patient outcome was documented six months after assessment. Results: The internal consistency for the CRS-R total score was excellent (Cronbach's α = 0.84). Good test-retest reliability was obtained for CRS-R total score and subscale scores (intra-class correlation coefficient [ICC] = 0.87 and ICC = 0.66-0.84, respectively). Inter-rater reliability was high (ICC = 0.719; p < 0.01). Concurrent validity was good between CRS-R total scale and GCS total scale. Diagnostic validity was excellent compared with GCS (emerged from UWS: 24%; emerged from MCS: 28%). When considering patient outcome, diagnostic validity was good. In addition, false-positive rates have been detected for both diagnoses. Conclusion: The Chinese version of the CRS-R is a reliable and sensitive tool and can discriminate patients in UWS, MCS, and EMCS successfully.

Misdiagnosis rate of the prolonged disorders of consciousness on a clinical consensus compared with a repeated Coma-Recovery Scale-Revised assessment

“…In addition, recent studies have shown similar results with a clinical consensus of a 35.3% misdiagnosis rate [23]. To date, several versions of the CRS-R scale have been developed and validated [24][25][26][27][28]; however, due to the influence of patients' awakening or consciousness fluctuations, movement defects, aphasia, and other problems [29][30][31], a single standard CRS-R behavior evaluation still leads to a certain percentage of a misdiagnosis rate. Therefore, a repeated behavior scale evaluation [32] and personalized item selections [33,34] of the neurobehavioral assessment instrument are recommended to be applied to the consciousness evaluations of clinical patients, which have the potential to improve the reliability/validity of a diagnosis.…”

“…Therefore, it is highly likely that the clinical worker is highly dependent on the patients' bedside behaviors in the patients' daily management and may not be using systematic and standardized behavioral assessment tools to diagnose awareness. In addition, it was found that the Glasgow Coma Scale (GCS) was widely used for almost all patients admitted to the hospital, and a previous study also showed that the scale was not appropriate for assessing a patient's level of consciousness [24]. Different from the GCS scale, the CRS-R scale has very clear MCS diagnostic criteria, and the evaluation consciousness from various angles can be used to diagnose the consciousness level of patients more sensitively, which greatly reduces the misdiagnosis of patients with prolonged DOC.…”

Misdiagnosis rate of the prolonged disorders of consciousness on a clinical consensus compared with a repeated Coma-Recovery Scale-Revised assessment

“…In addition, recent studies have shown similar results with a clinical consensus of a 35.3% misdiagnosis rate [20]. To date, several versions of the CRS-R scale have been developed and validated [21][22][23][24][25]; however, due to the influence of patients' awakening or consciousness fluctuations, movement defects, aphasia, and other problems [26][27][28], a single standard CRS-R behavior evaluation still leads to a certain percentage of a misdiagnosis rate. Therefore, a repeated behavior scale evaluation [29] and personalized item selections [30,31] of the neurobehavioral assessment instrument are recommended to be applied to the consciousness evaluations of clinical patients, which have the potential to improve the reliability/validity of a diagnosis.…”

“…Therefore, it is highly likely that the clinical worker is highly dependent on the patients' bedside behaviors in the patients' daily management and may not be using systematic and standardized behavioral assessment tools to diagnose awareness. In addition, it was found that the Glasgow Coma Scale (GCS)was widely used for almost all patients admitted to the hospital, and a previous study also showed that the scale was not appropriate for assessing a patient's level of consciousness [21]. Different from the GCS scale, the CRS-R scale has very clear MCS diagnostic criteria, and the evaluation consciousness from various angles can be used to diagnose the consciousness level of patients more sensitively, which greatly reduces the misdiagnosis of patients with prolonged DOC.…”

The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated Coma-Recovery Scale-Revised assessment

“…In addition, recent studies have shown similar results, with a misdiagnosis rate of 35.3% for clinical consensus [22]. To date, several versions of the CRS-R scale have been developed and validated [23][24][25][26][27]; however, due to the in uence of patients' awakening or consciousness uctuations, movement defects, aphasia, and other problems [28][29][30], a single standard CRS-R behavior evaluation still leads to a nonzero rate of misdiagnosis. Therefore, repeated behavior scale evaluations [31] and personalized item selection [32,33] of the neurobehavioralassessment instrument have been for consciousness evaluations of clinical patients in order to improve the reliability of diagnosis.…”