Chaturvedi Jitender, Mudgal Shiv Kumar, Venkataram Tejas, Gupta Priyanka, Goyal Nishant, Jain Gaurav, Sharma Anil Kumar, Sharma Suresh Kumar, Bendok Bernard R
Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Nursing, Akal College of Nursing, Eternal University, Baru Sahib, Himachal Pradesh, India.
Surg Neurol Int. 2021 Mar 8;12:93. doi: 10.25259/SNI_935_2020. eCollection 2021.
Disorders of consciousness (DoC) includes coma, vegetative state (VS), minimally conscious state (MCS), and emergence from the MCS. Aneurysmal rupture with high-grade SAH, traumatic brain injury, and neoplastic brain lesions are some of the frequent pathologies leading to DoC. The diagnostic errors among these DoC are as high as ranging from 25% to 45%, with a probable error in the conclusion of patients' state, treatment choice, end-of-life decision-making, and prognosis. Some studies also reported that 37-43% of patients were misdiagnosed in VS while demonstrating signs of awareness. Despite its wide acceptance, Coma Recovery Scale-Revised (CRS-r) remained underused or inappropriately utilized, which may lead to substandard or unprofessional patient care. Literature is rare on the knowledge of CRS-r among physicians published from India and across the globe. Therefore, we carried out the present study to ascertain physicians' knowledge on CRS-r and raise awareness about its justifiable clinical utilization. We also explored the factors associated with this perceived level of experience among participants and recommend frequent physicians' training for care of patients with DoC.
An institution-based cross-sectional online survey was conducted from June 8 to July 7, 2020, among Ninety-six physicians recruited using a convenient sampling technique. Twenty-item, validated, reliable, and a pilot-tested questionnaire was used to assess the knowledge regarding CRS-r and collect socio-demographic variables. The analysis was performed using the Statistical Package for the Social Sciences version 23. Bivariate and multivariate logistic regression analyses were employed to assess the association of participants' socio-demographic variables and their parent department of work with the knowledge. < 0.05 was considered statistically significant in the multivariate analysis.
A total of Ninety-six participants were included in the analysis, and only 33.3% of them were found to have adequate knowledge of CRS-r. Multivariate analysis revealed that age (adjusted odds ratio [AOR] = 31.66; 95% CI: 6.25-160.36), gender (AOR = 44.16; 95% CI: 7.43-268.23), and parent department of working (AOR = 0.148; 95% CI: 0.06-0.39) were significantly associated with the knowledge.
Knowledge of the physicians on CRS-r is found to be exceptionally low. It has a strong tendency to adversely affect patients' optimal care with disorders of consciousness (DoC). Therefore, it is crucial to expand physicians' knowledge and awareness regarding CRS-r to adequately screen patients with DoC.
意识障碍（DoC）包括昏迷、植物状态（VS）、最低意识状态（MCS）以及从MCS中苏醒。伴有高级别蛛网膜下腔出血（SAH）的动脉瘤破裂、创伤性脑损伤和脑肿瘤病变是导致DoC的一些常见病因。这些意识障碍中的诊断错误高达25%至45%，可能在患者状态的判断、治疗选择、临终决策和预后方面出现错误。一些研究还报告称，37%至43%的处于植物状态但显示出意识迹象的患者被误诊。尽管昏迷恢复量表修订版（CRS-r）已被广泛接受，但仍未得到充分利用或使用不当，这可能导致患者护理不达标或不专业。关于印度和全球范围内发表的医生对CRS-r知识的文献很少。因此，我们开展了本研究，以确定医生对CRS-r的了解情况，并提高对其合理临床应用的认识。我们还探讨了与参与者这种感知经验水平相关的因素，并建议对医生进行关于意识障碍患者护理的频繁培训。
2020年6月8日至7月7日，采用方便抽样技术招募了96名医生，进行了一项基于机构的横断面在线调查。使用一份经过验证、可靠且经过预测试的20项问卷来评估关于CRS-r的知识，并收集社会人口统计学变量。使用社会科学统计软件包第23版进行分析。采用双变量和多变量逻辑回归分析来评估参与者的社会人口统计学变量及其工作所在科室与知识之间的关联。多变量分析中，P < 0.05被认为具有统计学意义。
共有96名参与者纳入分析，其中只有33.3%的人对CRS-r有足够的了解。多变量分析显示，年龄（调整后的优势比[AOR] = 31.66；95%置信区间：6.25 - 160.36）、性别（AOR = 44.16；95%置信区间：7.43 - 268.23）和工作所在科室（AOR = 0.148；95%置信区间：0.06 - 0.39）与知识显著相关。
发现医生对CRS-r的了解极低。这极有可能对意识障碍（DoC）患者的最佳护理产生不利影响。因此，扩大医生对CRS-r的知识和认识以充分筛查意识障碍患者至关重要。
