Wessex Head Injury Matrix and Glasgow/Glasgow-Liege Coma Scale: A Validation and Comparison Study

Abstract

The Wessex Head Injury Matrix (WHIM) is an assessment tool designed for use during and immediately after coma. The aim of this study was (1) to test a French adaptation of the WHIM, (2) to compare the WHIM to the Glasgow Coma Scale (GCS) and its extension, the Glasgow-Liège Coma Scale (GLS), and (3) to confirm the sequence of emergence of behaviours. The three scales were used to assess 23 patients admitted to an intensive care unit with a GCS score equal to or less than 8 for at least 1 hour, longitudinally. Results indicated that the WHIM had good concurrent validity with the GCS and GLS, good inter-rater agreement, and excellent test-retest reliability . The WHIM is more appropriate and sensitive than the GCS and the GLS for the period of emerging from coma and immediately afterwards, whereas the GLS is more appropriate than the WHIM for the deepest phase of coma, as it also assesses brainstem reflexes. Furthermore, analysis of our data confirmed the ordering of the 66 items of the WHIM as a function of sequence of recovery from coma, as suggested by its authors.

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

“…Four behavioural scales were administered in a randomized order by an experienced neuropsychologist (CS) to assess the patients' level of consciousness: the Glasgow Coma Scale (GCS) [6], the Full Outline of UnResponsiveness scale (FOUR) [16], the Wessex Head Injury Matrix (WHIM) [12,13] and the French version of the CRS-R. In order to ensure sufficient arousal level, each behavioural scale was administered while the patients showed eye opening.…”

“…The FOUR includes four sub-scales (eye and motor responses, brainstem reflexes and respiration) scored from 0 (worst) to 16 (best) [16]. The French version of the WHIM validated by Majerus and Van der Linden [13] was used. This scale includes a hierarchical sequence of 62 items.…”

“…The WHIM is an ordinal scale reflecting an empirically derived sequence of recovery, based on the observation of the recovery pattern of 80 severely brain injured patients [12]. This scale is reported to be sensitive from exit of the coma period to complete recovery of awareness [13]. Finally, the Coma Recovery Scale-Revised (CRS-R) is based on the Aspen workgroup criteria for the minimally conscious state and is a reliable tool that can distinguish patients in the minimally conscious state from those in a vegetative state [14].…”

Behavioral assessment in patients with disorders of consciousness: gold standard or fool's gold?

“…The Wessex Head Injury Matrix (WHIM) (Shiel et al, 2000) was developed to capture changes in patients in VS through emergence from post traumatic amnesia. This tool is particularly sensi tive to detecting changes in patients in MCS not captured by traditional scales such as the GCS (Majerus and Van der Linden, 2000). Shiel and collaborators longitudinally followed 97 severely brain-injured patients recovering from coma to create the WHIM.…”

Bispectral analysis of electroencephalogram signals during recovery from coma: Preliminary findings

“…The WHIM score represents the rank order of the most advanced behaviour observed and was designed for the assessment of patients in and emerging from coma and in the vegetative and minimally conscious states. It has been shown to be superior to the GCS and GLS scales for detecting subtle changes in patients emerging from vegetative state and for patients in a minimally conscious state (Majerus & Van der Linden, 2000) and is scored from 1 (worst) to 62 (best) (Schnakers, Majerus, & Laureys, 2004).…”