Journal
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Volume 97, Issue 8, Pages 1295-1300Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.apmr.2016.02.009
Keywords
Brain injuries; Consciousness disorders; Outcome assessment (health care); Rehabilitation
Categories
Funding
- National Institute on Disability, Independent Living, and Rehabilitation Research, Department of Health and Human Services, Administration for Community Living [90DP0039-01-00]
- James S. McDonnell Foundation
- Harvard Catalyst \ The Harvard Clinical and Translational Science Center (National Center for Research Resources)
- Harvard Catalyst \ The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health) [UL1 TR001102]
- Harvard University and its affiliated academic health care centers
- Belgian American Educational Foundation
- Wallonie Bruxelles International Concerted Research Action
- Belgian Funds for Scientific Research, European Commission
- European Foundation for Biomedical Research
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Objective: To determine the frequency with which specific Coma Recovery Scale-Revised (CRS-R) subscale scores co-occur as a means of providing clinicians and researchers with an empirical method of assessing CRS-R data quality. Design: We retrospectively analyzed CRS-R subscale scores in hospital inpatients diagnosed with disorders of consciousness (DOCs) to identify impossible and improbable subscore combinations as a means of detecting inaccurate and unusual scores. Impossible subscore combinations were based on violations of CRS-R scoring guidelines. To determine improbable subscore combinations, we relied on the Mahalanobis distance, which detects outliers within a distribution of scores. Subscore pairs that were not observed at all in the database (ie, frequency of occurrence = 0%) were also considered improbable. Setting: Specialized DOC program and university hospital. Participants: Patients diagnosed with DOCs (N=1190; coma: n=76, vegetative state: n=464, minimally conscious state: n=586, emerged from minimally conscious state: n=64; 794 men; mean age, 43 +/- 20y; traumatic etiology: n=747; time postinjury, 162 +/- 568d). Interventions: Not applicable. Main Outcome Measure: Impossible and improbable CRS-R subscore combinations. Results: Of the 1190 CRS-R profiles analyzed, 4.7% were excluded because they met scoring criteria for impossible co-occurrence. Among the 1137 remaining profiles, 12.2% (41/336) of possible subscore combinations were classified as improbable. Conclusions: Clinicians and researchers should take steps to ensure the accuracy of CRS-R scores. To minimize the risk of diagnostic error and erroneous research findings, we have identified 9 impossible and 36 improbable CRS-R subscore combinations. The presence of any one of these subscore combinations should trigger additional data quality review. (C) 2016 by the American Congress of Rehabilitation Medicine
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