Abstract
Objective: To determine whether repeated examinations using the Coma Recovery Scale-Revised 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.
Methods: 123 adult patients with chronic disorders of consciousness were referred to our tertiary center. They were assessed at least 6 times with the Coma Recovery Scale-Revised within a 10-day period. Clinical diagnoses based on 1, 2, 3, 4, and 5 Coma Recovery Scale-Revised assessments were compared with a reference diagnosis (i.e., the highest behavioral diagnosis obtained after 6 evaluations) using non-parametric statistics. Results were considered significant at P<0.05 corrected for multiple comparisons.
Results: 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 6 CRS-R assessments. Compared to this reference diagnosis, the first evaluation led to 36% of misdiagnoses.
Interpretation: The number of Coma Recovery Scale-Revised 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 5 assessments in each patient with disorders of consciousness within a short time interval (e.g., 2 weeks) to reduce misdiagnosis. This article is protected by copyright. All rights reserved.
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