Citation

Portaccio E, Morrocchesi A, Romoli AM, Hakiki B, Taglioli MP, Lippi E, Di Renzone M, Grippo A, Macchi C. Arch. Phys. Med. Rehabil. 2018; 99(5): 914-919.

Affiliation

IRCCS Don Gnocchi Foundation, Italy; University of Florence, Italy.

Copyright

(Copyright © 2018, Elsevier Publishing)

DOI

10.1016/j.apmr.2018.01.015

PMID

29428346

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 from severe brain injury DESIGN: prospective cohort study PARTICIPANTS: Patients consecutively admitted to the Intensive Rehabilitation Unit at the IRCCS Don Gnocchi Foundation (Florence, Italy). Inclusion criteria were diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) due to acquired brain injury, age older than 18 years. INTERVENTIONS: All the 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 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 hospital stay of 5.3 + 2.7 months, 59 out of 110 patients (53.6%) of the patients achieved an IR. In the multivariable analysis, higher CRS-R score change at week 4 (OR 1.99; 95%CI 1.49-2.66; p<0.001) 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 higher CRS-R score at admission (B=0.051; 95%CI 0.027-0.074; p<0.001), higher CRS-R score change at week 4 (B=0.087; 95%CI 0.064-0.110; p<0.001), and absence of severe infections (B= -0.477; 95%CI -0.778/-0.176; p=0.002).

CONCLUSIONS: An improvement on the total CRS-R score and on different subscales across the first four weeks of inpatient rehabilitation discriminates patients who will encounter a better outcome at discharge, providing information for rehabilitation planning and communication with patients and their caregivers.

Copyright © 2018. Published by Elsevier Inc.

Language: en

Keywords

Coma Recovery Scale-Revised; intensive rehabilitation; prognosis; severe brain injury