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Arch Phys Med Rehabil. 2016 Aug;97(8):1295-1300.e4. doi: 10.1016/j.apmr.2016.02.009. Epub 2016 Mar 2.

Detection and Interpretation of Impossible and Improbable Coma Recovery Scale-Revised Scores.

Author information

1
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA; Laboratory for NeuroImaging of Coma and Consciousness, Massachusetts General Hospital, Boston, MA; Coma Science Group, GIGA-Research Center, University Hospital of Liège, Liège, Belgium. Electronic address: cchatelle@partners.org.
2
Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA.
3
Coma Science Group, GIGA-Research Center, University Hospital of Liège, Liège, Belgium.
4
Coma Science Group, GIGA-Research Center, University Hospital of Liège, Liège, Belgium; Departments of Psychology and Psychiatry, University of Wisconsin, Madison, WI.
5
Crawford Research Institute, Shepherd Center, Atlanta, GA.

Erratum in

Abstract

OBJECTIVE:

To determine the frequency with which specific Coma Recovery Scale-Revised (CRS-R) subscale scores co-occur as a means of providing clinicians and researchers with an empirical method of assessing CRS-R data quality.

DESIGN:

We retrospectively analyzed CRS-R subscale scores in hospital inpatients diagnosed with disorders of consciousness (DOCs) to identify impossible and improbable subscore combinations as a means of detecting inaccurate and unusual scores. Impossible subscore combinations were based on violations of CRS-R scoring guidelines. To determine improbable subscore combinations, we relied on the Mahalanobis distance, which detects outliers within a distribution of scores. Subscore pairs that were not observed at all in the database (ie, frequency of occurrence=0%) were also considered improbable.

SETTING:

Specialized DOC program and university hospital.

PARTICIPANTS:

Patients diagnosed with DOCs (N=1190; coma: n=76, vegetative state: n=464, minimally conscious state: n=586, emerged from minimally conscious state: n=64; 794 men; mean age, 43±20y; traumatic etiology: n=747; time postinjury, 162±568d).

INTERVENTIONS:

Not applicable.

MAIN OUTCOME MEASURE:

Impossible and improbable CRS-R subscore combinations.

RESULTS:

Of the 1190 CRS-R profiles analyzed, 4.7% were excluded because they met scoring criteria for impossible co-occurrence. Among the 1137 remaining profiles, 12.2% (41/336) of possible subscore combinations were classified as improbable.

CONCLUSIONS:

Clinicians and researchers should take steps to ensure the accuracy of CRS-R scores. To minimize the risk of diagnostic error and erroneous research findings, we have identified 9 impossible and 36 improbable CRS-R subscore combinations. The presence of any one of these subscore combinations should trigger additional data quality review.

KEYWORDS:

Brain injuries; Consciousness disorders; Outcome assessment (health care); Rehabilitation

PMID:
26944708
PMCID:
PMC6095641
DOI:
10.1016/j.apmr.2016.02.009
[Indexed for MEDLINE]
Free PMC Article

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