Article

OBJECTIVE: To describe the sensitivity and specificity of Coma Recovery
Scale-Revised (CRS-R) total scores in detecting conscious awareness. DESIGN: Data
were retrospectively extracted from the medical records of patients enrolled in a
specialized disorders of consciousness (DOC) program. Sensitivity and specificity
analyses were completed using CRS-R-derived diagnoses of minimally conscious
state (MCS) or emerged from minimally conscious state (EMCS) as the reference
standard for conscious awareness and the total CRS-R score as the test criterion.
A receiver operating characteristic curve was constructed to demonstrate the
optimal CRS-R total cutoff score for maximizing sensitivity and specificity.
SETTING: Specialized DOC program. PARTICIPANTS: Patients enrolled in the DOC
program (N=252, 157 men; mean age, 49y; mean time from injury, 48d; traumatic
etiology, n=127; nontraumatic etiology, n=125; diagnosis of coma or vegetative
state, n=70; diagnosis of MCS or EMCS, n=182). INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Sensitivity and specificity of CRS-R total scores in
detecting conscious awareness. RESULTS: A CRS-R total score of 10 or higher
yielded a sensitivity of .78 for correct identification of patients in MCS or
EMCS, and a specificity of 1.00 for correct identification of patients who did
not meet criteria for either of these diagnoses (ie, were diagnosed with
vegetative state or coma). The area under the curve in the receiver operating
characteristic curve analysis is .98. CONCLUSIONS: A total CRS-R score of 10 or
higher provides strong evidence of conscious awareness but resulted in a
false-negative diagnostic error in 22% of patients who demonstrated conscious
awareness based on CRS-R diagnostic criteria. A cutoff score of 8 provides the
best balance between sensitivity and specificity, accurately classifying 93% of
cases. The optimal total score cutoff will vary depending on the user's
objective.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS