Molteni Erika, Colombo Katia, Pastore Valentina, Galbiati Susanna, Recla Monica, Locatelli Federica, Galbiati Sara, Fedeli Claudia, Strazzer Sandra
School of Biomedical Engineering & Imaging Sciences, and Centre for Medical Engineering, King's College, London SE1 7EU, UK.
Neuropsychological and Cognitive-behavioral Service, Neurophysiatric Department, Scientific Institute, I.R.C.C.S. Eugenio Medea, 23842 Bosisio Parini, Italy.
Brain Sci. 2020 Mar 12;10(3):162. doi: 10.3390/brainsci10030162.
The present study aimed to: (a) characterize the emergence to a conscious state (CS) in a sample of children and adolescents with severe brain injury during the post-acute rehabilitation and through two different neuropsychological assessment tools: the Rappaport Coma/Near Coma Scale (CNCS) and Level of Cognitive Functioning Assessment Scale (LOCFAS); (b) compare the evolution in patients with brain lesions due to traumatic and non-traumatic etiologies; and (c) describe the relationship between the emergence to a CS and some relevant clinical variables. In this observational prospective longitudinal study, 92 consecutive patients were recruited. Inclusion criteria were severe disorders of consciousness (DOC), Glasgow Coma Scale (GCS) score ≤8 at insult, age 0 to 18 years, and direct admission to inpatient rehabilitation from acute care. The main outcome measures were CNCS and LOCFAS, both administered three and six months after injury. The cohort globally shifted towards milder DOC over time, moving from overall 'moderate/near coma' at three months to 'near/no coma' at six months post-injury. The shift was captured by both CNCS and LOCFAS. CNCS differentiated levels of coma at best, while LOCFAS was superior in characterizing the emergence from coma. Agreement between scales was , and reduced negative findings at less than 10%. Patients with traumatic brain injury (TBI) vs. non-traumatic brain injury (NTBI) were older and had neurosurgical intervention more frequently. No relation between age and the level of consciousness was found overall. Concurrent administration of CNCS and LOCFAS reduced the rate of false negatives and better detected signs of arousal and awareness. This provides indication to administer both tools to increase measurement precision.
(a) 通过两种不同的神经心理学评估工具，即拉帕波特昏迷/近昏迷量表(CNCS)和认知功能水平评估量表(LOCFAS)，对急性康复期重度脑损伤儿童和青少年样本中意识状态(CS)的出现情况进行特征描述；(b) 比较创伤性和非创伤性病因导致脑损伤患者的病情演变；(c) 描述意识状态出现与一些相关临床变量之间的关系。在这项观察性前瞻性纵向研究中，连续招募了92例患者。纳入标准为严重意识障碍(DOC)、受伤时格拉斯哥昏迷量表(GCS)评分≤8分、年龄0至18岁，以及从急性护理直接转入住院康复。主要结局指标为CNCS和LOCFAS，均在受伤后3个月和6个月进行评估。随着时间推移，该队列总体上向较轻的DOC转变，从受伤后3个月时的总体“中度/近昏迷”转变为6个月时的“近无昏迷”。CNCS和LOCFAS均捕捉到了这种转变。CNCS对昏迷程度的区分效果最佳，而LOCFAS在表征从昏迷中苏醒方面更具优势。量表之间的一致性为 ，阴性结果减少至不到10%。创伤性脑损伤(TBI)患者与非创伤性脑损伤(NTBI)患者年龄更大，神经外科干预更为频繁。总体上未发现年龄与意识水平之间的关系。同时使用CNCS和LOCFAS可降低假阴性率，并能更好地检测觉醒和意识迹象。这为同时使用这两种工具以提高测量精度提供了依据。
