Coma Science Group, GIGA-Research & Neurology Department, University and University Hospital of Liege, Liege, Belgium.
Centre de recherche en neuroscience de Lyon (CRNL), équipe CAP, INSERM, U1028, CNRS, UMR5292, Lyon, France.
Ann Neurol. 2017 Jun;81(6):883-889. doi: 10.1002/ana.24962.
To determine whether repeated examinations using the Coma Recovery Scale-Revised (CRS-R) have an impact on diagnostic accuracy of patients with disorders of consciousness and to provide guidelines regarding the number of assessments required for obtaining a reliable diagnosis.
One hundred twenty-three adult patients with chronic disorders of consciousness were referred to our tertiary center. They were assessed at least six times with the CRS-R within a 10-day period. Clinical diagnoses based on one, two, three, four, and five Coma Recovery Scale-Revised assessments were compared with a reference diagnosis (ie, the highest behavioral diagnosis obtained after six evaluations) using nonparametric statistics. Results were considered significant at p < 0.05 corrected for multiple comparisons.
The number of assessments had a significant effect on the clinical diagnosis. Up to the fourth examination, the diagnosis was still statistically different from the reference diagnosis based on six CRS-R assessments. Compared to this reference diagnosis, the first evaluation led to 36% of misdiagnoses.
The number of CRS-R assessments has an impact on the clinical diagnosis of patients with chronic disorders of consciousness. Up to the fourth examinations, behavioral fluctuations may still impact the diagnostic accuracy. We here suggest performing at least five assessments in each patient with disorders of consciousness within a short time interval (eg, 2 weeks) to reduce misdiagnosis. Ann Neurol 2017;81:883-889 Ann Neurol 2017;81:883-889.
确定使用修订版昏迷恢复量表（CRS-R）重复检查是否会影响意识障碍患者的诊断准确性，并提供关于获得可靠诊断所需评估次数的指南。
123 名患有慢性意识障碍的成年患者被转诊到我们的三级中心。他们在 10 天内至少接受了 6 次 CRS-R 评估。使用非参数统计方法，将基于单次、两次、三次、四次和五次 CRS-R 评估的临床诊断与参考诊断（即经过六次评估后获得的最高行为诊断）进行比较。结果在经多重比较校正后，p 值 < 0.05 时被认为具有统计学意义。
评估次数对临床诊断有显著影响。直到第四次检查，诊断仍与基于六次 CRS-R 评估的参考诊断存在统计学差异。与该参考诊断相比，首次评估导致 36%的误诊。
CRS-R 评估次数对慢性意识障碍患者的临床诊断有影响。在第四次检查之前，行为波动仍可能影响诊断准确性。因此，我们建议在短时间内（例如 2 周内）对每位意识障碍患者至少进行 5 次评估，以减少误诊。Ann Neurol 2017;81:883-889。
