Validation of the Italian version of the Coma Recovery Scale-Revised (CRS-R)

Primary objective: To validate the Italian version of the Coma Recovery Scale-Revised (CRS-R). Methods: Two observers applied the Italian version of the CRS-R to selected patients. On day 1, observer A and B independently scored each patient; the comparison of their observations was used to evaluate inter-observer agreement. On day 2, observer A completed a second evaluation and the comparison of this observation with that obtained on day 1 by the same observer was used to evaluate test-re-test agreement. For each evaluation, also diagnostic impression (vegetative state/minimally conscious state) was reported. Results: Thirty-eight patients were evaluated (mean age +/- SD, 58.9 +/- 13.8 years). Inter-observer (rho = 0.81; p < 0.001) as well as test-re-test agreement (rho = 0.97; p < 0.001) for the total score was high. Inter-observer agreement was excellent for the communication sub-scale, good for the auditory, visual and motor sub-scales and moderate for the oromotor/verbal and arousal sub-scales. Test-re-test agreement was excellent for the visual, motor, oromotor/verbal and communication sub-scales, good for the auditory sub-scale and moderate for the arousal sub-scale. When considering the diagnostic impression, inter-observer agreement was good (kappa = 0.75; p < 0.001) and test-re-test agreement was excellent (kappa = 0.92; p < 0.001). Conclusions: The Italian version of the CRS-R can be administered reliably and can be also employed to discriminate patients in vegetative and in minimally conscious state.