The influence of the CRS-R score on functional outcome in patients with severe brain injury receiving early rehabilitation

Abstract

Background The aim of the study was to determine the role of the Coma Recovery Scale-Revised (CRS-R) in the prediction of functional status at the end of neurological early rehabilitative treatment. Methods Patients consecutively admitted to intensive or intermediate care units of a neurological rehabilitation center were enrolled in the study. Consciousness and functional status were assessed with the Coma Recovery Scale-Revised (CRS-R) and the Early Rehabilitation Barthel Index (ERBI), respectively. Both assessments were carried out weekly within the first month and at the end of early rehabilitation. Patient and clinical data were entered into a binary logistic regression model to predict functional status at discharge. Results 327 patients (112 females, 215 males) with a median age of 63 years (IQR = 53–75) and a median disease duration of 18 days (IQR = 12–28) were included. Most patients suffered from stroke (59 %), followed by traumatic brain injury (31 %), and hypoxic ischemic encephalopathy (10 %). Upon admission, 12 % were diagnosed as comatose, 31 % as unresponsive wakefulness syndrome (UWS), 35 % as minimally conscious state (MCS) and 22 % already emerged from MCS (eMCS). Of all patients undergoing complete early rehabilitative treatment (n = 180), 72 % showed improvements in level of consciousness (LOC). In this group, age, initial CRS-R score and gains in CRS-R score after four weeks independently predicted functional outcome at discharge. Conclusions The study confirms the relevance of the CRS-R score for functional outcome prediction. High CRS-R scores and young age facilitate functional improvements and increase the probability to continue treatment in subsequent rehabilitation phases. Moreover, results indicate that recovery might occur over a period of time that extends beyond acute care.

One-year outcome of brain injured patients undergoing early neurological rehabilitation: a prospective observational study

“…These results confirm previous findings that MCS patients are more likely to recover within the first year after disease onset than patients in UWS, in particular when they improve to MCS within the first month [ 2 , 5 ]. While a previous study from our group has shown that initial CRS-R score as well gains after 4 weeks predicted outcome at the end of post-acute rehabilitation [ 12 ], these findings do not apply to the one-year outcome. Since a considerable number of patients regain minimal or full consciousness during post-acute rehabilitation, the final assessment of consciousness may have a higher predictive value for the long-term outcome than the initial assessment.…”

“…Several studies, however, suggest that a considerable proportion of critically ill patients recover later, in particular during post-acute inpatient rehabilitation [ 6 – 8 ] or even years after the injury [ 9 – 11 ]. In a recent study investigating critically ill patients receiving post-acute rehabilitation, outcome at discharge was independently predicted by age, initial CRS-R score and gains in CRS-R score after 4 weeks [ 12 ]. The present study aims to extend previous findings by following up the outcome of these patients 1 year after discharge.…”

Pulmonary infection in traumatic brain injury patients undergoing tracheostomy: predicators and nursing care

“…Studies [ 2 – 4 ] have found that organ failure and secondary infection after brain trauma are the most important causes of death. The literature reports [ 5 , 6 ] a fatality rate that can reach 50.17%, and the concurrent pulmonary infection rate can be as high as 60.84%. STBI patients are prone to secondary pulmonary infection, which can significantly increase the disability and mortality of patients [ 7 , 8 ].…”

Stimulation-related modifications of evolving functional brain networks in unresponsive wakefulness

“…For the behavioral assessment of consciousness, the revised Coma Recovery Scale (CRS-R) is being applied in addition to clinical consensus as part of the clinical routine by trained staff, which is familiar with the CRS-R scoring system 36 , 37 . The CRS-R is an internationally accepted instrument for the monitoring of disorders of consciousness providing a rough estimate of the functional outcome as well 38 . The CRS-R encompasses six subscales that are each built in a hierarchical order with increasing scores indicating an increase in complexity of behavior.…”