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Abstract：
BACKGROUND: Previous studies have shown that a single Coma-Recovery Scale-Revision (CRS-R) assessment can identify high rates of misdiagnosis by clinical consensus. The aim of this study was to investigate the proportion of misdiagnosis by clinical consensus compared to repeated behavior-scale assessments in patients with prolonged disorders of consciousness (DOC).
METHODS: Patients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical-consensus diagnosis. Trained professionals used the CRS-R to evaluate the consciousness levels of the enrolled patients repeatedly (≥5 times) within a week. Based on the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Finally, the relationship between the results of the CRS-R and the clinical consensus were analyzed.
RESULTS: In this study, 137 patients with a clinical-consensus diagnosis of prolonged DOC were enrolled. It was found that 24.7% of patients with clinical UWS were actually in MCS after a single CRS-R behavior evaluation, while the repeated CRS-R evaluation results showed that the proportion of misdiagnosis of MCS was 38.2%. A total of 16.7% of EMCS patients were misdiagnosed with clinical MCS, and 1.1% of EMCS patients were misdiagnosed with clinical UWS.
CONCLUSIONS: The rate of the misdiagnosis by clinical consensus is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool in daily procedures.
BACKGROUND: ClinicalTrials.gov ID: NCT04139239 ; Registered 24 October 2019 - Retrospectively registered.
METHODS: Patients with prolonged DOC during hospitalization were screened by clinicians, and the clinicians formed a clinical-consensus diagnosis. Trained professionals used the CRS-R to evaluate the consciousness levels of the enrolled patients repeatedly (≥5 times) within a week. Based on the repeated evaluation results, the enrolled patients with prolonged DOC were divided into unresponsive wakefulness syndrome (UWS), minimally conscious state (MCS), and emergence from MCS (EMCS). Finally, the relationship between the results of the CRS-R and the clinical consensus were analyzed.
RESULTS: In this study, 137 patients with a clinical-consensus diagnosis of prolonged DOC were enrolled. It was found that 24.7% of patients with clinical UWS were actually in MCS after a single CRS-R behavior evaluation, while the repeated CRS-R evaluation results showed that the proportion of misdiagnosis of MCS was 38.2%. A total of 16.7% of EMCS patients were misdiagnosed with clinical MCS, and 1.1% of EMCS patients were misdiagnosed with clinical UWS.
CONCLUSIONS: The rate of the misdiagnosis by clinical consensus is still relatively high. Therefore, clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the CRS-R tool in daily procedures.
BACKGROUND: ClinicalTrials.gov ID: NCT04139239 ; Registered 24 October 2019 - Retrospectively registered.
摘要：
背景：先前的研究表明，单一昏迷恢复量表修订（CRS-R）评估可以通过临床共识识别高误诊率。这项研究的目的是调查长期意识障碍（DOC）患者的临床共识与重复行为量表评估相比，误诊的比例。
方法：由临床医生筛选住院期间DOC延长的患者，和临床医生形成了临床共识诊断。经过培训的专业人员使用CRS-R在一周内反复（≥5次）评估入选患者的意识水平。根据重复评估结果，纳入的DOC延长患者分为反应迟钝的觉醒综合征（UWS），最低意识状态（MCS），以及MCS(EMCS)的出现。最后,分析CRS-R的结果与临床共识之间的关系.
结果：在这项研究中，纳入137例临床共识诊断为延长DOC的患者。结果发现，24.7%的临床UWS患者在一次CRS-R行为评估后实际上处于MCS，而重复CRS-R评估结果显示MCS的误诊比例为38.2%。共有16.7%的EMCS患者被误诊为临床MCS,1.1%的EMCS患者被误诊为临床UWS。
结论：临床共识误诊率仍较高。因此,临床医生应意识到床边CRS-R行为评估的重要性,并应在日常手术中应用CRS-R工具.
背景：ClinicalTrials.govID：NCT04139239；2019年10月24日注册-回顾性注册。
方法：由临床医生筛选住院期间DOC延长的患者，和临床医生形成了临床共识诊断。经过培训的专业人员使用CRS-R在一周内反复（≥5次）评估入选患者的意识水平。根据重复评估结果，纳入的DOC延长患者分为反应迟钝的觉醒综合征（UWS），最低意识状态（MCS），以及MCS(EMCS)的出现。最后,分析CRS-R的结果与临床共识之间的关系.
结果：在这项研究中，纳入137例临床共识诊断为延长DOC的患者。结果发现，24.7%的临床UWS患者在一次CRS-R行为评估后实际上处于MCS，而重复CRS-R评估结果显示MCS的误诊比例为38.2%。共有16.7%的EMCS患者被误诊为临床MCS,1.1%的EMCS患者被误诊为临床UWS。
结论：临床共识误诊率仍较高。因此,临床医生应意识到床边CRS-R行为评估的重要性,并应在日常手术中应用CRS-R工具.
背景：ClinicalTrials.govID：NCT04139239；2019年10月24日注册-回顾性注册。
