Feasibility and Validity of the Coma Recovery Scale-Revised For Accelerated Standardized Testing (CRSR-FAST): A Practical Assessment Scale for Detecting Consciousness in the Intensive Care Unit

• Published in: Archives of physical medicine and rehabilitation Vol. 105; no. 4; p. e117
• Main Authors: Bodien, Yelena, Vora, Isha, Barra, Alice, Chiang, Kevin, Chatelle, Camille, Goostrey, Kelsey, Martens, Geraldine, Mello, Jennifer, Parlman, Kristin, Ranford, Jessica, Sterling, Ally, Waters, Abigail, Hirschberg, Ronald, Katz, Douglas, Mazwi, Nicole, Ni, Pengsheng, Velmahos, George, Waak, Karen, Edlow, Brian, Giacino, Joseph
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2024
• Subjects: Brain Injury; Coma Recovery Scale-Revised; Intensive Care Unit; Brain Injury; Coma Recovery Scale-Revised; Intensive Care Unit
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2024.02.330

To develop and test the feasibility, reliability and validity of the Coma Recovery Scale-Revised For Accelerated Standardized Testing (CRSR-FAST), a short form of the CRS-R for use in the Intensive Care Unit (ICU).
Three trained examiners completed 4 study examinations (1 CRS-R and 3 CRSR-FAST assessments) over a maximum period of 48 hours to establish concurrent validity, interrater reliability and test-retest reliability. The full-length CRS-R served as the reference standard and examiners were masked to patient diagnosis and other CRS-R findings (except for test-retest reliability). Test administration order and assignment of raters to testing condition (i.e., reliability or validity) was pseudo-randomized to prevent order effects.
Intensive Care Unit at a Level I trauma center.
Forty-five consecutively-enrolled patients with traumatic disorders of consciousness receiving care in the ICU.
N/A.
Duration of CRSR-FAST administration (feasibility); Agreement between CRSR-FAST and full-length CRS-R determination of consciousness (concurrent validity); Agreement between CRSR-FAST scores obtained by the same rater on two consecutive examinations (test-retest reliability); Agreement between CRSR-FAST scores obtained by two different raters on the same day (inter-rater reliability).
Forty-five participants (mean [SD] age 44 [20] years, 67% male, 8 [5] days post injury, CRS-R Total Score = 7 [5], CRS-R range = 1-22) completed the study. The sensitivity, specificity, and accuracy of the CRSR-FAST for detecting consciousness were 81%, 89%, and 84%, respectively. Simple kappa for concurrent validity, Mak's rho for test-retest reliability and inter-rater reliability were 0.68, 0.76 and 0.91, respectively (i.e., substantial). CRSR-FAST administration time was 6.5 [3] minutes.
Preliminary findings suggest that the CRSR-FAST is a feasible and valid tool for serial assessment of consciousness in the ICU. The CRSR-FAST may improve diagnostic accuracy, facilitate decision-making regarding continuation of life-sustaining therapy, aid disposition planning, and improve acute and post-acute care coordination.
None.