Keech Kristen, Schnakers Caroline, Murtaugh Brooke, O'Brien Katherine, Slomine Beth, Briand Marie-Michèle, Formisano Rita, Thibaut Aurore, Estraneo Anna, Noé Enrique, Gosseries Olivia, da Conceição Teixeira Liliana
The Queen's Medical Center, Honolulu, HI 96813, USA.
Doctor of Occupational Therapy Program, Hawaii Pacific University, Honolulu, HI 96813, USA.
Brain Sci. 2025 Jan 15;15(1):71. doi: 10.3390/brainsci15010071.
Clinicians are challenged by the ambiguity and uncertainty in assessing level of consciousness in individuals with disorder of consciousness (DoC). There are numerous challenges to valid and reliable neurobehavioral assessment and classification of DoC due to multiple environmental and patient-related biases including behavioral fluctuation and confounding or co-occurring medical conditions. Addressing these biases could impact accuracy of assessment and is an important aspect of the DoC assessment process.
A pre-assessment checklist was developed by a group of interdisciplinary DoC clinical experts and researchers based on the existing literature, current validated tools, and expert opinions. Once finalized, the checklist was electronically distributed to clinicians with a range of experience in neurobehavioral assessment with DoC. Respondents were asked to use the checklist prior to completing a neurobehavioral assessment. A survey was also provided to respondents to obtain feedback regarding checklist feasibility and utility in optimizing the behavioral assessments.
Thirty-three clinicians completed the survey after using the checklist. Over half of the respondents were a combination of physicians, neuropsychologists, and physical therapists. All respondents served the adult DoC population and 42% percent had over ten years of clinical experience. Eighty percent reported they found the format of the checklist useful and easy to use. All respondents reported the checklist was relevant to preparing for behavioral assessment in the DoC population. Eighty-four percent reported they would recommend the use of the tool to other clinicians.
The use of a pre-assessment checklist was found to be feasible and efficacious in increasing interdisciplinary clinician's ability to optimize the patient and environment in preparation for neurobehavioral assessment. Initial results of clinicians' perception of the utility of a pre-assessment checklist were positive. However, further validation of the tool is needed with larger sample sizes to improve representation of clinical use across disciplines and care settings.
临床医生在评估意识障碍（DoC）患者的意识水平时面临着模糊性和不确定性的挑战。由于多种环境和患者相关的偏差，包括行为波动以及混杂或同时存在的医疗状况，对DoC进行有效且可靠的神经行为评估和分类存在诸多挑战。解决这些偏差可能会影响评估的准确性，并且是DoC评估过程的一个重要方面。
一组跨学科的DoC临床专家和研究人员基于现有文献、当前经过验证的工具以及专家意见，制定了一份预评估清单。清单最终确定后，通过电子方式分发给在DoC神经行为评估方面具有不同经验的临床医生。要求受访者在完成神经行为评估之前使用该清单。还向受访者提供了一项调查，以获取有关清单在优化行为评估方面的可行性和实用性的反馈。
33名临床医生在使用清单后完成了调查。超过一半的受访者是医生、神经心理学家和物理治疗师的组合。所有受访者都服务于成年DoC患者群体，42%的人拥有超过十年的临床经验。80%的受访者表示他们发现清单的格式有用且易于使用。所有受访者都报告说该清单与为DoC患者群体进行行为评估的准备工作相关。84%的受访者表示他们会向其他临床医生推荐使用该工具。
发现使用预评估清单在提高跨学科临床医生优化患者和环境以准备神经行为评估的能力方面是可行且有效的。临床医生对预评估清单效用的初步看法是积极的。然而，需要用更大的样本量对该工具进行进一步验证，以改善跨学科和护理环境中临床使用的代表性。
