A new tool to assess responsiveness in disorders of consciousness (DoC): a preliminary study on the Brief Post-Coma Scale (BPCS)

on the behalf of the Italian National Consortium on Functioning and Disability in Disorders of Consciousness Patients, Rita Formisano, Marta Aloisi, Marco Iosa, Marianna Contrada, Federica Rizza, Davide Sattin, Matilde Leonardi, Mariagrazia D'Ippolito, Sandra Strazzer, Federica Villa, Antonio Trabacca, Leonarda Gennaro, Andrea Martinuzzi, Mara Buffoni

Research output: Contribution to journalArticlepeer-review

Abstract

INTRODUCTION: The Brief Post-Coma Scale (BPCS) is an easy diagnostic tool for individuals with disorders of consciousness (DoC), in a reduced version from a previously Post-Coma Scale, that could distinguish patients in the minimally conscious state (MCS) from those in unresponsive wakefulness syndrome (UWS), formerly defined as vegetative state (VS).

OBJECTIVE: Aim of the study was to assess the diagnostic validity of the BPCS in comparison with the Coma Recovery Scale-Revised (CRS-R), in its Italian validated version, the Disability Rating Scale (DRS), the Level of Cognitive Functioning (LCF), and the Glasgow Outcome Scale (GOS).

METHODS: In an Italian multicenter study on 545 patients with DoC, 36 post-acute rehabilitation wards, 32 long-term care centers, and 2 family associations participated to data collection.

RESULTS: Statistically significant correlations were found between the BPCS and the other clinical scales: R = 0.586 (p < 0.001) with LCF, R = - 0.566 (p < 0.001) with DRS, R = 0.622 (p < 0.001) with CRS-R. The BPCS scores resulted significantly correlated with the time from acute event (R = 0.117, p = 0.006). Patients with GOS score 2 had mean BPCS of 1.84 ± 1.19, whereas those with GOS 3 had significantly higher scores 3.88 ± 1.71 (p < 0.001). Similarly, in patients with vegetative state/UWS (VS/UWS), the mean BPSC score was 1.71 ± 1.09, significantly lower (p < 0.001) than that of patients with minimally conscious state (BPCS = 3.83 ± 1.29). Finally, the agreement of the BPCS and clinical diagnosis was of 84.4%, with an odds ratio OR = 3.781 (95% CI = 3.026-4.725, p < 0.001).

CONCLUSIONS: The BPCS has demonstrated statistically significant correlations with the most commonly used scales in persons with DoC.

Original languageEnglish
Pages (from-to)1651-1656
Number of pages6
JournalNeurological Sciences
Volume39
Issue number9
DOIs
Publication statusPublished - Sep 2018

Keywords

  • Area Under Curve
  • Brain Injuries, Traumatic/complications
  • Consciousness Disorders/diagnosis
  • Diagnosis, Differential
  • Disability Evaluation
  • Female
  • Glasgow Outcome Scale
  • Humans
  • Italy
  • Long-Term Care
  • Male
  • Middle Aged
  • Outcome Assessment (Health Care)
  • Preliminary Data
  • ROC Curve
  • Rehabilitation Centers
  • Reproducibility of Results

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