Assessment Scales for Disorders of Consciousness: Evidence-Based Recommendations for Clinical Practice and Research

摘要: Abstract Report of the American Congress Rehabilitation Medicine, Brain Injury-Interdisciplinary Special Interest Group, Disorders Consciousness Task Force: Seel RT, Force Chair, Sherer M, Whyte J, Katz DI, Giacino JT, Rosenbaum AM, Hammond FM, Kalmar K, Pape TL, Zafonte R, Biester RC, Kaelin D, Kean Zasler N. Assessment scales for disorders consciousness: evidence-based recommendations clinical practice and research. Objectives To conduct a systematic review behavioral assessment consciousness (DOC); provide use based on their content validity, reliability, diagnostic ability to predict functional outcomes; research DOC scale development validation. Data Sources Articles published through March 31, 2009, using MEDLINE, CINAHL, Psychology Behavioral Sciences Collection, Cochrane Database Systematic Reviews, Abstracts Reviews Effects, Central Register Controlled Trials, Biomedical Reference PsycINFO. Thirteen primary terms that defined were paired with 30 secondary aspects measurement. Scale names, abbreviations, authors also used as search terms. force members identified additional articles by personal knowledge examination references in reviewed articles. Study Selection Primary criteria included following: (1) provided and/or prognostic validity data; (2) examined cohort, case control, or series sample persons who age older than equal 18 years; (3) assessed an acute care rehabilitation setting. excluded if peer was not conducted, original data reported, English language article available. The initial yielded 580 After rater study abstracts, guideline 37 representing 13 scales. Extraction Rater pairs classified studies addressing Academy Neurology 4-tier level evidence scheme, reliability task force–developed 3-tier scheme. An independent quality ratings corrections made. Synthesis Coma Recovery Scale-Revised (CRS-R), Sensory Stimulation Measure (SSAM), Wessex Head Injury Matrix (WHIM), Western Neuro Profile (WNSSP), Modality Technique (SMART), (DOCS), Coma/Near-Coma (CNC) have acceptable standardized administration scoring procedures. CRS-R has excellent is only address all Aspen Workgroup criteria. SMART, SSAM, WHIM, WNSSP demonstrate good containing items could distinguish are vegetative state, minimally conscious state (MCS), emerged from MCS. Full Outline UnResponsiveness Score (FOUR), WNSSP, CRS-R, Comprehensive Levels (CLOCS), Innsbruck (INNS) showed substantial internal consistency. FOUR interrater reliability. Evidence brain injury survivor samples had very high levels potential bias because methodologic issues such lack masking. Conclusions may be assess minor reservations, DOCS moderate reservations. CNC major FOUR, INNS, Glasgow-Liege Scale, Swedish Reaction Level Scale-1985, Loewenstein Communication CLOCS recommended at this time bedside standardization, unproven