Camille Chatelle1, Yelena G Bodien2, Cecilia Carlowicz2, Sarah Wannez3, Vanessa Charland-Verville3, Olivia Gosseries4, Steven Laureys3, Ron T Seel5, Joseph T Giacino2. 1. 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. 2. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Boston, MA. 3. Coma Science Group, GIGA-Research Center, University Hospital of Liège, Liège, Belgium. 4. Coma Science Group, GIGA-Research Center, University Hospital of Liège, Liège, Belgium; Departments of Psychology and Psychiatry, University of Wisconsin, Madison, WI. 5. Crawford Research Institute, Shepherd Center, Atlanta, GA.
Abstract
OBJECTIVE: 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. DESIGN: 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. SETTING: Specialized DOC program and university hospital. PARTICIPANTS: 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). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Impossible and improbable CRS-R subscore combinations. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: 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. DESIGN: 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. SETTING: Specialized DOC program and university hospital. PARTICIPANTS: 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). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Impossible and improbable CRS-R subscore combinations. RESULTS: 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. CONCLUSIONS: 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.
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