Feasibility and Validity of the Coma Recovery Scale-Revised For Accelerated Standardized Testing (CRSR-FAST): A Practical Assessment Scale for Detecting Consciousness in the Intensive Care Unit

Research Objectives: To develop and test the feasibility, reliability and validity of the Coma Recovery Scale-Revised For Accelerated Standardized Testing (CRSR-FAST), a short form of the CRS-R for use in the Intensive Care Unit (ICU).

Design: Three trained examiners completed 4 study examinations (1 CRS-R and 3 CRSR-FAST assessments) over a maximum period of 48 hours to establish concurrent validity, interrater reliability and test-retest reliability. The full-length CRS-R served as the reference standard and examiners were masked to patient diagnosis and other CRS-R findings (except for test-retest reliability). Test administration order and assignment of raters to testing condition (i.e., reliability or validity) was pseudo-randomized to prevent order effects.

Setting: Intensive Care Unit at a Level I trauma center

Participants: Forty-five consecutively-enrolled patients with traumatic disorders of consciousness receiving care in the ICU.

Interventions: N/A

Main Outcome Measures: Duration of CRSR-FAST administration (feasibility); Agreement between CRSR-FAST and full-length CRS-R determination of consciousness (concurrent validity); Agreement between CRSR-FAST scores obtained by the same rater on two consecutive examinations (test-retest reliability); Agreement between CRSR-FAST scores obtained by two different raters on the same day (inter-rater reliability).

Results: Forty-five participants (mean [SD] age 44 [20] years, 67% male, 8 [5] days post injury, CRS-R Total Score = 7 [5], CRS-R range = 1-22) completed the study. The sensitivity, specificity, and accuracy of the CRSR-FAST for detecting consciousness were 81%, 89%, and 84%, respectively. Simple kappa for concurrent validity, Mak’s rho for test-retest reliability and inter-rater reliability were 0.68, 0.76 and 0.91, respectively (i.e., substantial). CRSR-FAST administration time was 6.5 [3] minutes.

Conclusions: Preliminary findings suggest that the CRSR-FAST is a feasible and valid tool for serial assessment of consciousness in the ICU. The CRSR-FAST may improve diagnostic accuracy, facilitate decision-making regarding continuation of life-sustaining therapy, aid disposition planning, and improve acute and post-acute care coordination.

Author(s) Disclosures: None