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

OBJECTIVES : 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 specialized expertise. In this study, we hypothesized 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.
SETTING AND PARTICIPANTS : Patients referred for 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 100mm visual analog scale,
blinded from the reference standard. Diagnostic accuracy was evaluated
using area under the receiver operating characteristic curve (AUC),
sensitivity and specificity metrics. RESULTS : 692 ratings performed by 83
nursing staff members were collected from 47 patients. Twenty patients
were in a UWS and 27 in a MCS. DoC-feeling scores obtained by pooling all
individual ratings obtained for a given patient were significantly greater
in MCS than in UWS patients (59.2 mm [IQR: 27.3-77.3] vs. 7.2 mm [IQR:
2.4-11.4]; p<0.001) yielding an AUC of 0.92 (95%CI: 0.84-0.99).
CONCLUSIONS: DoC-feeling capitalizes on the expertise of nursing staff to
evaluate patients’ consciousness. Together with the CRS-R as well as with
brain imaging, DoC-feeling might improve diagnostic and prognostic
accuracy of DoC patients.