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Archives of Physical Medicine and Rehabilitation

Year, Volume, Issue, Page(s):

, 97, 8, 1295-1300, e.1-e.4

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Study determined 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. Participants were 1,190 hospital inpatients diagnosed with disorders of consciousness: coma: 76, vegetative state: 464, minimally conscious state: 586, emerged from minimally conscious state:64; 794 men; mean age, 43 years; traumatic etiology: 747; mean time postinjury, 162 days. The participants’ CRS-R subscale scores were analyzed 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, researchers relied on the Mahalanobis distance, which detects outliers within a distribution of scores. Subscore pairs that were not observed at all in the database were also considered improbable. Of the 1,190 CRS-R profiles analyzed, 4.7 percent were excluded because they met scoring criteria for impossible co-occurrence. Among the 1137 remaining profiles, 12.2 percent of possible subscore combinations were classified as improbable. 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, 9 impossible and 36 improbable CRS-R subscore combinations were identified. The presence of any one of these subscore combinations should trigger additional data quality review.


Chatelle, Camille, Bodien, Yelena G., Carlowicz, Cecilia, Wannez, Sarah, Charland-Verville, Vanessa, Gosseries, Olivia, Laureys, Steven, Seel, Ron T., Giacino, Joseph T.