Improvement on the Coma Recovery Scale–Revised During the First Four Weeks of Hospital Stay Predicts Outcome at Discharge in Intensive Rehabilitation After Severe Brain Injury

Intensive Rehabilitation Unit Study Group of the IRCCS Don Gnocchi Foundation, Italy

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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. Design: Prospective cohort study. 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.

Original languageEnglish
JournalArchives of Physical Medicine and Rehabilitation
DOIs
Publication statusPublished - May 2018

Fingerprint

Coma
Brain Injuries
Length of Stay
Rehabilitation
Persistent Vegetative State
Glasgow Outcome Scale
Confidence Intervals
Wakefulness
Caregivers
Inpatients
Cohort Studies
Odds Ratio
Communication
Outcome Assessment (Health Care)
Prospective Studies
Infection

Keywords

  • Brain injury
  • Coma
  • Prognosis
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Improvement on the Coma Recovery Scale–Revised During the First Four Weeks of Hospital Stay Predicts Outcome at Discharge in Intensive Rehabilitation After Severe Brain Injury. / Intensive Rehabilitation Unit Study Group of the IRCCS Don Gnocchi Foundation, Italy.

In: Archives of Physical Medicine and Rehabilitation, 05.2018.

Research output: Contribution to journalArticle

@article{18b4729651574483a54e0085aa1040d8,
title = "Improvement on the Coma Recovery Scale–Revised During the First Four Weeks of Hospital Stay Predicts Outcome at Discharge in Intensive Rehabilitation After Severe Brain Injury",
abstract = "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. Design: Prospective cohort study. 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.",
keywords = "Brain injury, Coma, Prognosis, Rehabilitation",
author = "Emilio Portaccio and Azzurra Morrocchesi and Romoli, {Anna Maria} and Bahia Hakiki and Taglioli, {Maria Pia} and Elena Lippi and {Di Renzone}, Martina and Antonello Grippo and Claudio Macchi and Tiziana Atzori and Barbara Binazzi and Roberta Boni and Marco Borsotti and Chiara Castagnoli and Riccardo Carrai and Francesca Cecchi and Loredana Croci and Irene Gall{\`i} and Antonello Grippo and Andrea Marella and Claudio Macchi and Anna Mazzucchi and {Molino Lova}, Raffaello and Emilio Portaccio and Sandro Sorbi and Ariela Tofani and Anita Paperini and Guido Pasquini and Maenia Scarpino and Federica Vannetti and {Intensive Rehabilitation Unit Study Group of the IRCCS Don Gnocchi Foundation, Italy}",
year = "2018",
month = "5",
doi = "10.1016/j.apmr.2018.01.015",
language = "English",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",

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TY - JOUR

T1 - Improvement on the Coma Recovery Scale–Revised During the First Four Weeks of Hospital Stay Predicts Outcome at Discharge in Intensive Rehabilitation After Severe Brain Injury

AU - Portaccio, Emilio

AU - Morrocchesi, Azzurra

AU - Romoli, Anna Maria

AU - Hakiki, Bahia

AU - Taglioli, Maria Pia

AU - Lippi, Elena

AU - Di Renzone, Martina

AU - Grippo, Antonello

AU - Macchi, Claudio

AU - Atzori, Tiziana

AU - Binazzi, Barbara

AU - Boni, Roberta

AU - Borsotti, Marco

AU - Castagnoli, Chiara

AU - Carrai, Riccardo

AU - Cecchi, Francesca

AU - Croci, Loredana

AU - Gallì, Irene

AU - Grippo, Antonello

AU - Marella, Andrea

AU - Macchi, Claudio

AU - Mazzucchi, Anna

AU - Molino Lova, Raffaello

AU - Portaccio, Emilio

AU - Sorbi, Sandro

AU - Tofani, Ariela

AU - Paperini, Anita

AU - Pasquini, Guido

AU - Scarpino, Maenia

AU - Vannetti, Federica

AU - Intensive Rehabilitation Unit Study Group of the IRCCS Don Gnocchi Foundation, Italy

PY - 2018/5

Y1 - 2018/5

N2 - 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. Design: Prospective cohort study. 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.

AB - 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. Design: Prospective cohort study. 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.

KW - Brain injury

KW - Coma

KW - Prognosis

KW - Rehabilitation

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DO - 10.1016/j.apmr.2018.01.015

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JO - Archives of Physical Medicine and Rehabilitation

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SN - 0003-9993

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