title: Coma recovery scale-r: variability in the disorder of consciousness.
abstract: BACKGROUND
  Despite evidence from neuroimaging research, diagnosis and early prognosis in the vegetative (VS/UWS) and minimally conscious (MCS) states still depend on the observation of clinical signs of responsiveness. Multiple testing has documented a systematic variability during the day in the incidence of established signs of responsiveness. Spontaneous fluctuations of the Coma Recovery Scale-revised (CRS-r) scores are conceivable.
  
  
  METHODS
  We retrospectively analyzed the CRS-r repeatedly administered to 7 VS/UWS and 12 MCS subjects undergoing systematic observation during a conventional 13 weeks. rehabilitation plan.
  
  
  RESULTS
  The CRS-r global, visual and auditory scores were found higher in the morning than at the afternoon administration in both VS/UWS and MCS subgroups over the entire period of observation. The probability for a VS/UWS subject of being classified as MCS at the morning testing at least once during the 13 weeks. observation was as high as 30%, i.e., compatible with the reported misdiagnosis rate between the two clinical conditions.
  
  
  CONCLUSIONS
  Multiple CRS-r testing is advisable to minimize the risk of misclassification; estimates of spontaneous variability could be used to characterize with greater accuracy patients with disorder of consciousness and possibly help optimize the rehabilitation plan.
authors.affiliation: Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy. d.cortese@istitutosantanna.it.
authors.forename: M D
authors.initials: MD
authors.lastname: Cortese
authors.affiliation: Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy. f.riganello@istitutosantanna.it.
authors.forename: F
authors.initials: F
authors.lastname: Riganello
authors.affiliation: Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy. f.arcuri@istitutosantanna.it.
authors.forename: F
authors.initials: F
authors.lastname: Arcuri
authors.affiliation: Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy. m.pugliese@istitutosantanna.it.
authors.forename: M E
authors.initials: ME
authors.lastname: Pugliese
authors.affiliation: Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy. l.lucca@istitutosantanna.it.
authors.forename: L F
authors.initials: LF
authors.lastname: Lucca
authors.affiliation: Institute S. Anna and RAN (Research in Advanced Rehabilitation), Crotone, Italy. giulianodolce@libero.it.
authors.forename: G
authors.initials: G
authors.lastname: Dolce
authors.affiliation: Department of Neuroscience, Ophthalmology and Genetics, University of Genova, 3, Largo P. Daneo, 16132, Genova, Italy. wgs@dism.unige.it.|Department of Psychiatry, State University of New York, Stony Brook, NY, USA. wgs@dism.unige.it.
authors.forename: W G
authors.initials: WG
authors.lastname: Sannita
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000145:classification*; D011379:Prognosis; D012189:Retrospective Studies