A Russian validation study of the Coma Recovery Scale-Revised (CRS-R)

European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness

“…PICO questions 1–3 refer to clinical signs, PICO questions 4–8 to clinical rating scales. Thirteen publications were included for final analysis . PICO 1 Should the patient's eyelids be opened by the examiner to diagnose voluntary eye movements in patients with DoC without spontaneous eye opening? …”

“…Eight studies conducted in different centers and countries including 925 patients were available for inclusion . The relative risk for detecting evidence of consciousness with the CRS‐R compared to other behavioral assessment methods, including unstructured neurological bedside examination, was 1.45 (95% CI 1.32–1.60; P < 0.0001), suggesting that the CRS‐R is more sensitive than other scales for detecting signs of consciousness . The CRS‐R is also the only scale that includes all criteria for MCS (with the notable exception that the CRS‐R does not include standardized assessment of appropriate emotional responses as signs of consciousness) .…”

“…Three studies compared the FOUR with the Glasgow Coma Scale (GCS) for the classification of DoC patients in the ICU ( n = 313) . Relative risk for evidence of consciousness detected by the FOUR compared to the GCS was 1.46 (95% CI 1.04–2.05; P = 0.03).…”

“…Recommendation: The task force group recommends that the FOUR score be used to assess the level of consciousness in patients with DoC in the ICU instead of the GCS ( moderate evidence, strong recommendation ). Although less sensitive than the CRS‐R, the FOUR score is more convenient for frequent evaluations by clinicians and nursing staff in the ICU, where time is often limited and patients are intubated . In contrast to the GCS, the FOUR includes assessment of eye movement, which reduces misdiagnosis of locked‐in syndrome and MCS and allows for a more precise distinction between comatose and recovering patients .…”

“…Although less sensitive than the CRS‐R, the FOUR score is more convenient for frequent evaluations by clinicians and nursing staff in the ICU, where time is often limited and patients are intubated . In contrast to the GCS, the FOUR includes assessment of eye movement, which reduces misdiagnosis of locked‐in syndrome and MCS and allows for a more precise distinction between comatose and recovering patients . PICO 7 Should the Nociception Coma Scale – Revised (NCS‐R) be used to diagnose signs of possible discomfort or nociception in patients with DoC? …”