title: Detection and Interpretation of Impossible and Improbable Coma Recovery Scale-Revised Scores.
abstract: To determine 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.
  
  
  
  We retrospectively analyzed CRS-R subscale scores in hospital inpatients diagnosed with disorders of consciousness (DOCs) 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, we relied on the Mahalanobis distance, which detects outliers within a distribution of scores. Subscore pairs that were not observed at all in the database (ie, frequency of occurrence=0%) were also considered improbable.
  
  
  
  Specialized DOC program and university hospital.
  
  
  
  Patients diagnosed with DOCs (N=1190; coma: n=76, vegetative state: n=464, minimally conscious state: n=586, emerged from minimally conscious state: n=64; 794 men; mean age, 43±20y; traumatic etiology: n=747; time postinjury, 162±568d).
  
  
  
  Not applicable.
  
  
  
  Impossible and improbable CRS-R subscore combinations.
  
  
  
  Of the 1190 CRS-R profiles analyzed, 4.7% were excluded because they met scoring criteria for impossible co-occurrence. Among the 1137 remaining profiles, 12.2% (41/336) 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, we have identified 9 impossible and 36 improbable CRS-R subscore combinations. The presence of any one of these subscore combinations should trigger additional data quality review.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA; Laboratory for NeuroImaging of Coma and Consciousness, Massachusetts General Hospital, Boston, MA; Coma Science Group, GIGA-Research Center, University Hospital of Liège, Liège, Belgium. Electronic address: cchatelle@partners.org.
authors.forename: Camille
authors.initials: C
authors.lastname: Chatelle
authors.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA.
authors.forename: Yelena G
authors.initials: YG
authors.lastname: Bodien
authors.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Carlowicz
authors.affiliation: Coma Science Group, GIGA-Research Center, University Hospital of Liège, Liège, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wannez
authors.affiliation: Coma Science Group, GIGA-Research Center, University Hospital of Liège, Liège, Belgium.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Charland-Verville
authors.affiliation: Coma Science Group, GIGA-Research Center, University Hospital of Liège, Liège, Belgium; Departments of Psychology and Psychiatry, University of Wisconsin, Madison, WI.
authors.forename: Olivia
authors.initials: O
authors.lastname: Gosseries
authors.affiliation: Coma Science Group, GIGA-Research Center, University Hospital of Liège, Liège, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
authors.affiliation: Crawford Research Institute, Shepherd Center, Atlanta, GA.
authors.forename: Ron T
authors.initials: RT
authors.lastname: Seel
authors.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Giacino
mesh_terms: D000328:Adult; D001143:Arousal / Q000502:physiology; D001930:Brain Injuries / Q000150:complications*; D003142:Communication; D003244:Consciousness Disorders / Q000209:etiology* / Q000534:rehabilitation*; D005260:Female; D006320:Hearing Tests; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D026741:Physical Therapy Modalities; D020127:Recovery of Function; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014787:Vision Tests
keywords: Brain injuries; Consciousness disorders; Outcome assessment (health care); Rehabilitation