Article

OBJECTIVES: To evaluate the prognostic utility of serial assessment on the Coma
Recovery Scale-Revised (CRS-R) during the first 4 weeks of intensive
rehabilitation in patients surviving a severe brain injury. SETTING: An intensive rehabilitation unit. PARTICIPANTS: Patients
(N=110) consecutively admitted to the intensive rehabilitation unit. Inclusion
criteria were (1) a diagnosis of unresponsive wakefulness syndrome (UWS) or
minimally conscious state (MCS) caused by an acquired brain injury, and (2) aged
>18 years. INTERVENTIONS: All patients underwent clinical evaluations using the
Italian version of the CRS-R during the first month of hospital stay. MAIN
OUTCOME MEASURES: Behavioral classification on the CRS-R and the score on the
Glasgow Outcome Scale (GOS) at final discharge. Patients transitioning from UWS
to MCS or emergence from MCS (E-MCS), and from MCS to E-MCS were classified as
patients with improved responsiveness (IR). RESULTS: After a mean +/- SD hospital
stay of 5.3+/-2.7 months, 59 of 110 patients (53.6%) achieved IR. In the
multivariable analysis, a higher CRS-R score change at week 4 (odds ratio =1.99;
95% confidence interval [CI], 1.49-2.66; P<.001) was the only significant
predictor of IR at discharge. Fifty-three patients (48.2%) were classified as
severely impaired at discharge (GOS=3). In the multivariable analysis, higher GOS
scores were related to a higher CRS-R score at admission (B=.051; 95% CI,
.027-.074; P<.001), a higher CRS-R score change at week 4 (B=.087; 95% CI,
.064-.110; P<.001), and an absence of severe infections (B=-.477; 95% CI, -.778
to -.176; P=.002). CONCLUSIONS: An improvement on the total CRS-R score and on
different subscales across the first 4 weeks of inpatient rehabilitation
discriminates patients who will have a better outcome at discharge, providing
information for rehabilitation planning and for communication with patients and their caregivers.
CI - Copyright (c) 2018 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS