Clinical assessment of patients with chronic disorders of consciousness by different medical specialists
- 作者: Solovyeva P.I.1, Sinkin M.V.1,2, Talypov A.E.1, Abzalova D.I.1, Ramazanov G.R.1, Mehia-Mehia E.D.2, Bakharev E.Y.1, Popugayev K.A.1,3, Grin A.A.1,2
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隶属关系:
- Sklifosovsky Research Institute for Emergency Care
- A.I. Evdokimov Moscow State Medicine and Dentistry University
- A.I. Burnazyan Medical and Biological University of Innovations and Continuing Education Federal Medical Biophysical Center
- 期: 卷 16, 编号 2 (2022)
- 页面: 44-49
- 栏目: Original articles
- URL: https://ogarev-online.ru/2075-5473/article/view/124054
- DOI: https://doi.org/10.54101/ACEN.2022.2.5
- ID: 124054
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Introduction. Clinical assessment of consciousness in patients coming out of a coma remains a topic of discussion. Monitoring these patients over time is challenging not only because of the slow fluctuations in their neurological status, but also because doctors are not fully aware of the classification of chronic disorders of consciousness (CDC), and how to use the Coma Recovery Scale-revised (CRS-R), which was specifically developed for this group of patients. In practice, most doctors use standard neurological examination to assess consciousness rather than the CRS-R. We have hypothesized that this approach leads to contradictory and poorly standardized results.
Materials and methods. We investigated the level of inter-expert reliability in pairs of three medical specialists: neurologists, neurosurgeons and neurocritical care specialists (working in neurocritical care units) in the clinical assessment of consciousness. Their examination findings were compared to the CRS-R scores.
Results. The inter-expert reliability was poor in all three specializations when using clinical examination to determine the degree of impaired consciousness in patients with CDC. An average level of IER (Cohen's kappa = 0.46) was found only in the neurosurgeon–CRS-R pair.
Conclusion. A scale with detailed criteria is different to a standard clinical examination and has a higher level of IER. Moving from subjective evaluation to a standardized CRS-R will enable medical specialists to determine a patient’s rehabilitation potential and predict disease progression more accurately. Educational programmes, including virtual platforms, should be developed to encompass most of the medical community.
作者简介
Polina Solovyeva
Sklifosovsky Research Institute for Emergency Care
编辑信件的主要联系方式.
Email: psolovyeva@yandex.ru
ORCID iD: 0000-0001-6858-6210
junior researcher, neurologist, Neurosurgical department
俄罗斯联邦, 129010, Moscow, Bol’shaya Sukharevskaya square, 3Mikhail Sinkin
Sklifosovsky Research Institute for Emergency Care; A.I. Evdokimov Moscow State Medicine and Dentistry University
Email: mvsinkin@gmail.com
ORCID iD: 0000-0001-5026-0060
Cand. Sci. (Med.), senior researcher, neurophysiology team leader, Neurosurgical department
俄罗斯联邦, 129010, Moscow, Bol’shaya Sukharevskaya square, 3; MoscowAlexander Talypov
Sklifosovsky Research Institute for Emergency Care
Email: psolovyeva@yandex.ru
ORCID iD: 0000-0002-6789-8164
D. Sci. (Med.), chief researcher, Neurosurgical department
俄罗斯联邦, 129010, Moscow, Bol’shaya Sukharevskaya square, 3Dilara Abzalova
Sklifosovsky Research Institute for Emergency Care
Email: psolovyeva@yandex.ru
ORCID iD: 0000-0002-7217-6940
junior researcher, neurologist, Neurosurgical department
俄罗斯联邦, 129010, Moscow, Bol’shaya Sukharevskaya square, 3Ganipa Ramazanov
Sklifosovsky Research Institute for Emergency Care
Email: psolovyeva@yandex.ru
ORCID iD: 0000-0001-6824-4114
Cand. Sci. (Med.), Head, Science division, Neurological department
俄罗斯联邦, 129010, Moscow, Bol’shaya Sukharevskaya square, 3Ester Mehia-Mehia
A.I. Evdokimov Moscow State Medicine and Dentistry University
Email: psolovyeva@yandex.ru
Head, Intensive care department
俄罗斯联邦, MoscowEvgeniy Bakharev
Sklifosovsky Research Institute for Emergency Care
Email: psolovyeva@yandex.ru
ORCID iD: 0000-0003-1525-1585
Cand. Sci. (Med.), neurosurgeon, Neurosurgical department
俄罗斯联邦, 129010, Moscow, Bol’shaya Sukharevskaya square, 3Konstantin Popugayev
Sklifosovsky Research Institute for Emergency Care; A.I. Burnazyan Medical and Biological University of Innovations and Continuing Education Federal Medical Biophysical Center
Email: psolovyeva@yandex.ru
ORCID iD: 0000-0002-6240-820X
D. Sci. (Med.), Professor, Deputy Director, Head, Regional Vascular Center, Head, Department of anesthesiology, resuscitation intensive care
俄罗斯联邦, 129010, Moscow, Bol’shaya Sukharevskaya square, 3; MoscowAndrey Grin
Sklifosovsky Research Institute for Emergency Care; A.I. Evdokimov Moscow State Medicine and Dentistry University
Email: psolovyeva@yandex.ru
ORCID iD: 0000-0003-3515-8329
D. Sci. (Med.), Professor, Chief neurosurgeon, Moscow Healthcare Department, Department of neurosurgery and neurocritical care, Head, Science division, Neurosurgical department
俄罗斯联邦, 129010, Moscow, Bol’shaya Sukharevskaya square, 3; Moscow参考
- Owen A.M., Coleman M.R. Detecting awareness in the vegetative state. Ann. N. Y. Acad. Sci. 2008; 1129: 130–138. doi: 10.1196/annals.1417.018
- Xie Q., Ni X., Yu R,. et al. Chronic disorders of consciousness. Exp. Ther. Med. 2017; 14(2): 1277–1283. doi: 10.3892/etm.2017.4639
- Cruse D., Chennu S., Chatelle C. et al. Bedside detection of awareness in the vegetative state: a cohort study. Lancet. 2011; 378(9809): 2088–2094. doi: 10.1016/S0140-6736(11)61224-5
- Schnakers C., Vanhaudenhuyse A., Giacino J. et al. Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment. BMC Neurol. 2009; 9: 35. doi: 10.1186/1471-2377-9-35
- Giacino J.T., Schnakers C., Rodriguez-Moreno D. et al. Behavioral assessment in patients with disorders of consciousness: gold standard or fool’s gold? Prog. Brain Res. 2009; 177: 33–48. doi: 10.1016/S0079-6123(09)17704-X
- Schnakers C., Giacino J., Kalmar K. et al. Does the FOUR score correctly diagnose the vegetative and minimally conscious states? Ann. Neurol. 2006; 60(6): 744–745; author reply 745. doi: 10.1002/ana.20919
- Schnakers C., Monti M.M. Towards improving care for disorders of consciousness. Nat. Rev. Neurol. 2020; 16(8): 405–406. doi: 10.1038/s41582-020-0358-y
- Wade D. Back to the bedside? Making clinical decisions in patients with prolonged unconsciousness. J. Med. Ethics. 2017; 43(7): 457–458. doi: 10.1136/medethics-2015-103140
- Nachev P., Hacker P.M. Covert cognition in the persistent vegetative state. Prog. Neurobiol. 2010; 91(1): 68–76. doi: 10.1016/j.pneurobio.2010.01.009
- Mashour G.A., Avidan M.S. Capturing covert consciousness. Lancet. 2013; 381(9863): 271–272. doi: 10.1016/S0140-6736(13)60094-X
- Jennett B., Plum F. Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet. 1972; 1(7753): 734–737. doi: 10.1016/s0140-6736(72)90242-5
- Plum F., Posner J.B. The diagnosis of stupor and coma. Contemp. Neurol. Ser. 1972; 10: 1–286.
- Multi-Society Task Force on PVS. Medical aspects of the persistent vegetative state (1). N. Engl. J. Med. 1994; 330(21): 1499–1508. doi: 10.1056/NEJM199405263302107
- Пирадов М.А., Супонева Н.А., Вознюк И.А. и др. Хронические нарушения сознания: терминология и диагностические критерии. Результаты первого заседания Российской рабочей группы по проблемам хронических нарушений сознания. Анналы клинической и экспериментальной неврологии. 2020; 14(1): 5–16. Piradov M.A., Suponeva N.A., Voznyuk I.A. et al. Chronic disorders of consciousness: terminology and diagnostic criteria. Results of the first meeting of the Russian working group on problems of chronic disorders of consciousness. Annals of clinical and experimental neurology. 2020; 14(1): 5–16. (In Russ.) doi: 10.25692/ACEN.2020.1.1
- Wade D.T. How often is the diagnosis of the permanent vegetative state incorrect? A review of the evidence. Eur. J. Neurol. 2018; 25(4): 619–625. doi: 10.1111/ene.13572
- Chaturvedi J., Mudgal S.K., Venkataram T. et al. Coma recovery scale: key clinical tool ignored enough in disorders of consciousness. Surg. Neurol. Int. 2021; 12: 93. doi: 10.25259/SNI_935_2020
- Iazeva E.G., Legostaeva L.A., Zimin A.A. et al. A Russian validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Inj. 2019; 33(2): 218–225. doi: 10.1080/02699052.2018.1539248
- McHugh M.L. Interrater reliability: the kappa statistic. Biochem. Med. (Zagreb). 2012; 22(3): 276–282.
- Союз реабилитологов России. Нейропсихологическая диагностика и реабилитация пациентов с нарушениями сознания после повреждения головного мозга: методические рекомендации. М., 2019. 81 с. Union of Rehabilitologists of Russia. Neuropsychological diagnostics and rehabilitation of patients with impaired consciousness after brain damage: methodological recommendations. Moscow, 2019. 81 p. (In Russ.)
- Giacino J.T., Kalmar K., Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility. Arch. Phys. Med. Rehabil. 2004; 85(12): 2020–2029. doi: 10.1016/j.apmr.2004.02.033
- American Congress of Rehabilitation Medicine, Brain Injury-Interdisciplinary Special Interest Group, Disorders of Consciousness Task Force et al. Assessment scales for disorders of consciousness: evidence-based recommendations for clinical practice and research. Arch. Phys. Med. Rehabil. 2010; 91(12): 1795–1813. doi: 10.1016/j.apmr.2010.07.218
- Binder M., Górska U., Wójcik-Krzemień A., Gociewicz K. A validation of the Polish version of the Coma Recovery Scale-Revised (CRSR). Brain Inj. 2018; 32(2): 242–246. doi: 10.1080/02699052.2017.1406991
- Schnakers C., Majerus S., Giacino J. et al. A French validation study of the Coma Recovery Scale-Revised (CRS-R). Brain Inj. 2008; 22(10): 786-792. doi: 10.1080/02699050802403557
- Mayer H., Nonn C., Osterbrink J., Evers G.C. Quality criteria of assessment scales--Cohen’s kappa as measure of interrator reliability (1). Pflege. 2004; 17(1): 36–46. (In German) doi: 10.1024/1012-5302.17.1.36
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