Feasibility and Validity of the Coma Recovery Scale-Revised for Accelerated Standardized Testing: A Practical Assessment Tool for Detecting Consciousness in the Intensive Care Unit

Abstract

We developed and validated an abbreviated version of the Coma Recovery Scale-Revised (CRS-R), the CRS-R For Accelerated Standardized Testing (CRSR-FAST), to detect conscious awareness in patients with severe traumatic brain injury in the intensive care unit. In 45 consecutively enrolled patients, CRSR-FAST administration time was approximately one-third of the full-length CRS-R (mean [SD] 6.5 [3.3] vs 20.1 [7.2] minutes, p < 0.0001). Concurrent validity (simple kappa 0.68), test-retest (Mak's ρ = 0.76), and interrater (Mak's ρ = 0.91) reliability were substantial. Sensitivity, specificity, and accuracy for detecting consciousness were 81%, 89%, and 84%, respectively. The CRSR-FAST facilitates serial assessment of consciousness, which is essential for diagnostic and prognostic accuracy. ANN NEUROL 2023;94:919-924.

Figure 1 :

The five core items of the CRSR-FAST are administered in order until a scoreable response is elicited or, for specified items, observed to occur spontaneously and meet the scoring criteria. The final rating is “conscious” if at least one of the core items is observed, or “not conscious” if none of these items are observed. There are three supplementary items, two of which can be used by the examiner to detect emergence from the minimally conscious state. Resting posture is recorded as the position of the extremities at rest, which can influence motor responses to noxious stimulation. Contextual factors that may confound assessment findings such as psychoactive medications, recent anesthesia, and intubation are recorded. Test Completion Codes are entered to establish the validity of the assessment and to record reasons for confounding or failure to complete the examination. The CRSR-FAST Administration and Scoring Manual is provided in the Supplementary Materials.