Wisdom of the caregivers: pooling individual subjective reports to diagnose states of consciousness in brain-injured patients, a monocentric prospective study

BMJ Open
Bertrand HermannPitié-Salpétrière hospital Neuro-ICU

Abstract

The clinical distinction between vegetative state/unresponsive wakefulness syndrome (UWS) and minimally conscious state (MCS) is a key step to elaborate a prognosis and formulate an appropriate medical plan for any patient suffering from disorders of consciousness (DoC). However, this assessment is often challenging and may require specialised expertise. In this study, we hypothesised that pooling subjective reports of the level of consciousness of a given patient across several nursing staff members can be used to clinically detect MCS. Patients referred to consciousness assessment were prospectively screened. MCS (target condition) was defined according to the best Coma Recovery Scale-Revised score (CRS-R) obtained from expert physicians (reference standard). 'DoC-feeling' score was defined as the median of individual subjective reports pooled from multiple staff members during a week of hospitalisation (index test). Individual ratings were collected at the end of each shift using a 100 mm Visual Analogue Scale, blinded from the reference standard. Diagnostic accuracy was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity and specificity metrics. 692 ratings performed by 83 nursing staff...Continue Reading

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Citations

Feb 25, 2020·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·D KondziellaUNKNOWN EAN Panel on Coma, Disorders of Consciousness
Jul 9, 2021·Neurocritical Care·Daniel KondziellaUNKNOWN contributing collaborators of the Curing Coma Campaign

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Software Mentioned

pROC
DoC
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feeling
R

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Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.