Score on Coma Recovery Scale-Revised at admission predicts outcome at discharge in intensive rehabilitation after severe brain injury

ABSTRACT

Objective: To assess the prognostic utility of the Coma Recovery Scale-Revised (CRS-R) in rehabilitation of patients surviving from severe brain injury.

Methods: In this prospective cohort study, all patients consecutively admitted to an Italian Intensive Rehabilitation Unit, with a diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) due to acquired brain injury, underwent clinical evaluations using the Italian version of the CRS-R. At discharge, patients transitioning from UWS to MCS or emergence from MCS (E-MCS) and from MCS to E-MCS were classified as improved responsiveness (IR). Score on the Glasgow Outcome Scale (GOS) at discharge was recorded.

Results: In total, 137 (66 UWS, 71 MCS) subjects were enrolled. After a mean hospital stay of 5.3 ± 2.9 months, 81 (59.1%) patients achieved an IR. In the multivariable analysis, IR was associated with higher CRS-R score at admission (p = 0.002) and younger age at injury (p = 0.010). Moreover, higher GOS scores at discharge were related to younger age at injury (p = 0.018), shorter time post-onset (p = 0.003) and higher CRS-R score at admission (p < 0.001).

Conclusions: Higher CRS-R scores at admission in intensive rehabilitation unit can help differentiate patients with better outcome at discharge, providing information for rehabilitation planning and communication with patients and their caregivers.

KEYWORDS:

• Coma Recovery Scale-Revised
• intensive rehabilitation
• severe brain injury
• prognosis

Acknowledgements

The Intensive Rehabilitation Unit Study Group of the IRCCS Don Gnocchi Foundation, Florence, Italy:Atzori Tiziana, Binazzi Barbara, Boni Roberta, Borsotti Marco, Carrai Riccardo, Castagnoli Chiara, Cecchi Francesca, Croci Loredana, Gallì Irene, Marella Andrea, Mazzucchi Anna, Molino Lova Raffaello, Sorbi Sandro, Tofani Ariela, Paperini Anita, Pasquini Guido, Scarpino Maenia, Vannetti Federica

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.