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Titre : | Improvement on the Coma Recovery ScaleRevised During the First Four Weeks of Hospital Stay Predicts Outcome at Discharge in Intensive Rehabilitation After Severe Brain Injury (2018) |
Auteurs : | Emilio Portaccio ; Azzurra Morrocchesi ; Anna Maria Romoli |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 99, n° 5, 2018) |
Article en page(s) : | p. 914-919 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Coma ; Pronostic ; Rééducation et réadaptation |
Mots-clés: | Brain Injuries ; Lésions encéphaliques ; Prognosis |
Résumé : |
Objectives To evaluate the prognostic utility of serial assessment on the Coma Recovery ScaleRevised (CRS-R) during the first 4 weeks of intensive rehabilitation in patients surviving a severe brain injury. Design Prospective cohort study. Setting An intensive rehabilitation unit. Participants Patients (N=110) consecutively admitted to the intensive rehabilitation unit. Inclusion criteria were (1) a diagnosis of unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS) caused by an acquired brain injury, and (2) aged >18 years. Interventions All patients underwent clinical evaluations using the Italian version of the CRS-R during the first month of hospital stay. Main Outcome Measures Behavioral classification on the CRS-R and the score on the Glasgow Outcome Scale (GOS) at final discharge. Patients transitioning from UWS to MCS or emergence from MCS (E-MCS), and from MCS to E-MCS were classified as patients with improved responsiveness (IR). Results After a mean + SD hospital stay of 5.3+2.7 months, 59 of 110 patients (53.6%) achieved IR. In the multivariable analysis, a higher CRS-R score change at week 4 (odds ratio =1.99; 95% confidence interval [CI], 1.492.66; P<.001 was the only significant predictor of ir at discharge. fifty-three patients were classified as severely impaired discharge in multivariable analysis higher gos scores related to a crs-r score admission ci .027 p change week .064 and an absence severe infections> Conclusions An improvement on the total CRS-R score and on different subscales across the first 4 weeks of inpatient rehabilitation discriminates patients who will have a better outcome at discharge, providing information for rehabilitation planning and for communication with patients and their caregivers. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/archives-of-physical-medicine-and-rehabilitation |