An Empirical Examination of the Aspen Consensus Criteria's Diagnostic Accuracy Using the Coma Recovery Scale-Revised...

Area of Science:

• Neurology
• Neuroscience
• Rehabilitation Medicine

Background:

• Patients with disorders of consciousness (DoC) face misdiagnosis, impacting care access.
• The Coma Recovery Scale-Revised (CRS-R) requires refined cut points for accurate patient stratification and research comparability.

Purpose of the Study:

• To empirically align CRS-R rating scale categories with states of consciousness (unresponsive wakefulness syndrome [UWS], minimally conscious state [MCS], emerged from MCS [eMCS]) on a Rasch-transformed scale.
• To generate and assess the sensitivity and specificity of new cut points for DoC diagnoses.

Main Methods:

• Utilized the Rasch measurement model to co-calibrate the CRS-R and two DoC diagnostic variables (Aspen-Based and Rasch-Derived) on a 0-100 unit equal-interval scale.
• Analyzed CRS-R data from 262 participants (1,442 records).
• Assessed sensitivity and specificity of UWS-MCS and MCS-eMCS cut points.

Main Results:

• Established new cut points: UWS <34.40, 34.40 ≤ MCS < 67.07, eMCS ≥67.07 units on the Rasch-Derived scale.
• Realigned four CRS-R rating scale categories, with 19% of records reflecting a higher state of consciousness after reclassification.
• Recommended improved UWS-MCS cut point of 34.40 and MCS-eMCS cut point of 67.07.

Conclusions:

• Empirically derived cut points enhance the diagnostic precision of the CRS-R for disorders of consciousness.
• Improved diagnostic accuracy can facilitate better access to medical and rehabilitation services for DoC patients.
• Further validation using multimodal approaches is recommended for the Rasch-Derived cut points.