Simplification of the coma recovery scale-revised in disorders of consciousness: A prospective observational study

The Coma Recovery Scale-Revised (CRS-R) is the gold standard behavioral assessment scale for diagnosis of patients with disorders of consciousness (DOC). The reliability of CRS-R in monitoring the state of consciousness is well established. It is widely used by experts working in the fields of DOC. However, it is complex, time-consuming and difficult to use by non-professionals. Hence, it is imperative to simplify the evaluation to ease clinical workflow and increase work efficiency. In this study we evaluated the accuracy of a simplified scale using only 8 most commonly observed behaviors from the standard 29-item CRS-R scale. To assess the diagnostic accuracy of the simplified evaluation process of CRS-R compared to the standard CRS-R, a total of 150 patients with DOC who were admitted to the Hospital of Zhejiang People's Armed Police between February 2020 and September 2021 were screened in a prospective, observational study. Two trained clinicians used the CRS-R and the simplified CRS-R to evaluate the consciousness level of the enrolled patients, respectively. SPSS 23 was used for statistical analysis. Weighted kappa was used to demonstrate the level of agreement between the two methods. A p-value < 0.01 was considered to be statistically significant. Kappa coefficient was 0.952 (95 % CI: 0.905-0.999, p < 0.01), which indicated that the difference was statistically significant, thereby suggesting satisfactory level of agreement between the diagnostic outcomes of the CRS-R and simplified CRS-R. The simplified CRS-R could determine the state of consciousness of patients with ease and high accuracy.