Validation of the Chinese version of the Coma Recovery Scale-Revised (CRS-R)

ABSTRACT

Primary Objective: This study aims to validate the Chinese version of the Coma Recovery Scale-Revised (CRS-R).

Methods: One hundred sixty-nine patients were assessed with both the CRS-R and the Glasgow Coma Scale (GCS), diagnosed as being in unresponsive wakefulness syndrome (UWS, formerly known as vegetative state), minimally conscious state (MCS), or emergence from MCS (EMCS). A subgroup of 50 patients has been assessed twice by the same rater, within 24 h. Patient outcome was documented six months after assessment.

Results: The internal consistency for the CRS-R total score was excellent (Cronbach’s α = 0.84). Good test–retest reliability was obtained for CRS-R total score and subscale scores (intra-class correlation coefficient [ICC] = 0.87 and ICC = 0.66–0.84, respectively). Inter-rater reliability was high (ICC = 0.719; p < 0.01). Concurrent validity was good between CRS-R total scale and GCS total scale. Diagnostic validity was excellent compared with GCS (emerged from UWS: 24%; emerged from MCS: 28%). When considering patient outcome, diagnostic validity was good. In addition, false-positive rates have been detected for both diagnoses.

Conclusion: The Chinese version of the CRS-R is a reliable and sensitive tool and can discriminate patients in UWS, MCS, and EMCS successfully.

KEYWORDS:

• Behavioral scale
• Coma Recovery Scale-Revised
• consciousness
• unresponsive wakefulness syndrome
• minimally conscious state

Acknowledgments

We greatly appreciate the statistical advices provided by Jiqian Fang.

Disclosure of interest

The authors report no conflict of interest.

Supplementary material

Supplementary data can be accessed here.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China under Grant 81471100; the National High Technology Research and Development Program of China (863 Program) under Grant 2015AA020514; the Hangzhou Normal University under Grant PD11002010002016; the Research Fund for International Young Scientists of the National Natural Science Foundation of China under Grant 811247008; the Medical Science and Technology Projects in Zhejiang Province under Grants 2013KYB213 and 2015KYA181; and the College students in Zhejiang Province Science and Technology Innovation Activities plan under Grant 2017R423055.