Validation to Brazilian Portuguese of the coma recovery scale-revised

Abstract

Background To improve the diagnostic accuracy of the state of consciousness of patients with severe brain injury, Giacino et al. introduced the Coma Recovery Scale (CRS) in 1991, which underwent revision in 2004, resulting in the revised CRS scale (CRS-R).

Objective To determine the concurrent validity, as well as inter- and intrarater agreement of the CRS-R's adaptation to Brazilian Portuguese.

Methods This study involved a sample of 30 patients with severe brain injury. Concurrent evaluations were also performed with the Glasgow Coma Scale (GCS) and the Full Outline of UnResponsiveness (FOUR) scale. A total of seven rehabilitation experts were recruited to assess the inter- and intrarater reliability agreement.

Results Interrater reliability was moderate to high for auditory, visual, motor, verbal, communication, and arousal subscales (Cohen weighted kappa = 0.765 to 0.892; p < 0.001). Significant inter and intrarater intraclass correlation coefficients were observed for the total CRS-R scores, all of which were statistically significant (p < 0.001). Also, total CRS-R scores exhibited a high correlation with the total GCS and FOUR scores, indicating acceptable concurrent validity (p < 0.001).

Conclusion The Brazilian Portuguese version of CRS-R can be reliably administered by trained examiners. This study demonstrated substantial to almost perfect interrater agreement for the total score and subscales, as well as high concurrent validity between the Brazilian Portuguese version of CRS-R and the other two standardized behavioral scales.

Resumo

Antecedentes Para melhorar a acurácia diagnóstica do estado da consciência de pacientes com lesão cerebral severa, foi desenvolvida a Escala de Recuperação do Coma em 1991, que passou por revisão em 2004, resultando na escala revisada (CRS-R).

Objetivo Determinar a validade concorrente, concordância inter- e intraexaminador da adaptação da CRS-R para o português do Brasil.

Métodos Este estudo envolveu uma amostra de 30 pacientes com lesão cerebral grave. As avaliações concorrentes foram realizadas com a Escala de Coma de Glasgow (ECG) e a escala Full Outline of UnResponsiveness (FOUR). Um total de sete especialistas em reabilitação foram recrutados para avaliar a concordância de confiabilidade inter- e intraexaminador.

Resultados A confiabilidade interexaminador foi de moderada a alta para as subescalas auditiva, visual, motora, verbal, comunicação e alerta (kappa ponderado de Cohen = 0,765 a 0,892; p < 0,001). Foram observados coeficientes de correlação intraclasse intra- e interexaminador significativos para os escores totais da CRS-R, todos estatisticamente significativos (p < 0,001). Adicionalmente, os escores totais da CRS-R apresentaram alta correlação com os escores ECG e FOUR totais, indicando validade concorrente aceitável (p < 0,001).

Conclusão A versão em português do Brasil da CRS-R pode ser administrada de forma confiável por examinadores treinados. Este estudo demonstrou uma concordância de confiabilidade interexaminador substancial a quase perfeita para os escores total e de subescalas, assim como alta validade concorrente entre a versão brasileira do CRS-R e as outras duas escalas comportamentais.

Keywords

Brain Injuries - Consciousness Disorders - Rehabilitation - Validation Study

Palavras-chave

Lesões Encefálicas - Transtornos da Consciência - Reabilitação - Estudo de Validação

Authors' Contributions

APSC: conceptualization, data curation, investigation, methodology, project administration, supervision, writing – original draft, and writing – review & editing; TNFVS: data curation, investigation, and writing – review & editing; CMC, RCM, PSP: data curation, investigation, and writing – review & editing; LCVBC: writing – review & editing; RXSN: investigation, writing – review & editing; LSV: formal analysis.

Editor-in-Chief: Hélio A. G. Teive.

Associate Editor: Eduardo Genaro Mutarelli.

Publikationsverlauf

Eingereicht: 19. Januar 2024

Angenommen: 25. Juli 2024

Artikel online veröffentlicht:
20. November 2024

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