Bodien Yelena G, Carlowicz Cecilia A, Chatelle Camille, Giacino Joseph T
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital-Harvard Medical School, Charlestown, MA.
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital-Harvard Medical School, Charlestown, MA.
Arch Phys Med Rehabil. 2016 Mar;97(3):490-492.e1. doi: 10.1016/j.apmr.2015.08.422. Epub 2015 Sep 3.
To describe the sensitivity and specificity of Coma Recovery Scale-Revised (CRS-R) total scores in detecting conscious awareness.
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.
Specialized DOC program.
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).
Not applicable.
Sensitivity and specificity of CRS-R total scores in detecting conscious awareness.
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.
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.
描述修订版昏迷恢复量表(CRS-R)总分在检测意识清醒方面的敏感性和特异性。
从参加专门的意识障碍(DOC)项目的患者病历中回顾性提取数据。使用CRS-R得出的最低意识状态(MCS)或从最低意识状态中苏醒(EMCS)的诊断作为意识清醒的参考标准,以CRS-R总分作为测试标准,完成敏感性和特异性分析。构建受试者工作特征曲线以展示使敏感性和特异性最大化的最佳CRS-R总分临界值。
专门的DOC项目。
参加DOC项目的患者(N = 252,157名男性;平均年龄49岁;受伤后平均时间48天;创伤性病因,n = 127;非创伤性病因,n = 125;昏迷或植物状态诊断,n = 70;MCS或EMCS诊断,n = 182)。
不适用。
CRS-R总分在检测意识清醒方面的敏感性和特异性。
CRS-R总分10分及以上对正确识别MCS或EMCS患者的敏感性为0.78,对正确识别不符合这两种诊断标准(即被诊断为植物状态或昏迷)患者的特异性为1.00。受试者工作特征曲线分析中的曲线下面积为0.98。
CRS-R总分10分及以上提供了意识清醒的有力证据,但在基于CRS-R诊断标准显示有意识清醒的患者中,有22%出现了假阴性诊断错误。临界值为8分时在敏感性和特异性之间提供了最佳平衡,能准确分类93%的病例。最佳总分临界值将根据使用者的目标而有所不同。