Detection and interpretation of impossible and improbable Coma Recovery Scale-Revised scores

Publication date: Available online 2 March 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): C. Chatelle, Y.G. Bodien, C. Carlowicz, S. Wannez, V. Charland-Verville, O. Gosseries, S. Laureys, R.T. Seel, J.T. Giacino
ObjectivesTo determine the frequency with which specific Coma Recovery Scale-Revised (CRS-R) subscale scores co-occur as a means of providing clinicians and researchers with an empirical method of assessing CRS-R data quality.DesignWe retrospectively analyzed CRS-R subscale scores in hospital inpatients diagnosed with DoC to identify impossible and improbable subscore combinations as a means of detecting inaccurate and unusual scores. Impossible subscore combinations were based on violations of CRS-R scoring guidelines. To determine improbable subscore combinations, we relied on the Mahalanobis distance which detects outliers within a distribution of scores. Subscore pairs that were not observed at all in the database (i.e., frequency of occurrence = 0%) were also considered improbable.SettingSpecialized DOC program and University hospital. Participants: 1190 patients diagnosed with DoC (coma= 76, VS= 464, MCS= 586, EMCS= 64; 794 males; mean age= 43±20 years; traumatic etiology= 747; time post injury= 162±568 days). Interventions: Not applicable.Main Outcome Measure(s)Impossible and improbable CRS-R subscore combinations.ResultsOf the 1190 CRS-R profiles analyzed, 4.7% were excluded because they met scoring criteria for impossible co-occurrence. Among the 1137 remaining profiles, 12.2% (41/336) of possible subscore combinations were classified as improbable. Conclusions: Clinicians and researchers should take steps to ensure the accuracy of CRS-R scores. To minimize the risk of diagnostic error and erroneous research findings, we have identified 9 impossible and 36 improbable CRS-R subscore combinations. The presence of any one of these subscore combinations should trigger additional data quality review. Key words: Assessment, disorders of consciousness, vegetative state, minimally conscious state, data quality.



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