IRCCS Don Gnocchi Foundation, Florence, Italy.
IRCCS Don Gnocchi Foundation, Florence, Italy.
Arch Phys Med Rehabil. 2018 May;99(5):914-919. doi: 10.1016/j.apmr.2018.01.015. Epub 2018 Feb 8.
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.
Prospective cohort study.
An intensive rehabilitation unit.
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.
All patients underwent clinical evaluations using the Italian version of the CRS-R during the first month of hospital stay.
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).
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).
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.
评估严重脑损伤患者在强化康复治疗的前 4 周内连续进行修订版昏迷恢复量表（CRS-R）评估的预后价值。
前瞻性队列研究。
强化康复病房。
连续收治于强化康复病房的患者（N=110）。纳入标准为：（1）因获得性脑损伤而患有无反应觉醒综合征（UWS）或最小意识状态（MCS）；（2）年龄＞18 岁。
所有患者在住院期间的第一个月内均接受意大利版 CRS-R 的临床评估。
CRS-R 行为分类和最终出院时格拉斯哥预后量表（GOS）评分。从 UWS 转为 MCS 或从 MCS 转为有睁眼运动（E-MCS）的患者，以及从 MCS 转为 E-MCS 的患者被归类为反应能力改善（IR）的患者。
在平均（±SD）5.3±2.7 个月的住院治疗后，110 例患者中有 59 例（53.6%）实现了 IR。在多变量分析中，第 4 周时 CRS-R 评分变化更高（比值比=1.99；95%置信区间[CI]，1.49-2.66；P<.001）是出院时 IR 的唯一显著预测因素。53 例患者（48.2%）出院时被归类为严重受损（GOS=3）。在多变量分析中，较高的 GOS 评分与入院时较高的 CRS-R 评分（B=.051；95%CI，.027-.074；P<.001）、第 4 周时 CRS-R 评分变化更大（B=.087；95%CI，.064-.110；P<.001）和无严重感染（B=-.477；95%CI，.778 至-.176；P=.002）有关。
在住院康复治疗的前 4 周内，总 CRS-R 评分和不同亚量表的改善可以区分出院时预后较好的患者，为康复计划提供信息，并为与患者及其照顾者的沟通提供信息。
