Family caregivers improve the diagnostic accuracy of disorders of consciousness: from remote to near-bed auditory stimulation.
Pasquale Moretta, Cinzia Femiano, Nicola D Cavallo and 6 others
PMID 38381451WHAT IT FOUND
Having a family caregiver deliver verbal instructions during consciousness assessments, whether in the room or via video, helped clinicians identify higher levels of consciousness in patients with severe brain injury.
This method reduced the risk of misdiagnosing patients as unresponsive.
Key findings
01Coma Recovery Scale-Revised (CRS-R) total scores were significantly higher when a family caregiver delivered verbal instructions, either in person or remotely, compared to when an examiner alone performed the assessment.
02The presence of a family caregiver changed the diagnosis for 5 out of 30 patients, moving them from a lower to a higher category of consciousness, including identifying two patients as Emergent Minimally Conscious State (EMCS) that the standard exam missed.
03This diagnostic benefit was seen only in patients diagnosed with a Minimally Conscious State; it did not significantly change scores or diagnoses for patients diagnosed with a Vegetative State/Unresponsive Wakefulness Syndrome.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The sample size was small (30 patients), limiting the generalizability of the findings. The study relied solely on behavioral responses, so it could not rule out covert consciousness (cognitive-motor dissociation) in patients who did not respond. The protocol focused on verbal stimulation, which may have underestimated patients whose subtle signs of consciousness are primarily visual. The benefit was not seen in patients diagnosed with VS/UWS, suggesting this approach may not help in differentiating VS/UWS from MCS in that specific subgroup.
Declared interests
The authors declare no conflicts of interest. The research was partially supported by the 'Ricerca Corrente' funding scheme of the Ministry of Health, Italy.
The easy way to misread this
Do not assume this method helps diagnose all patients with disorders of consciousness. The study found no significant difference in scores or diagnoses for patients classified as Vegetative State/Unresponsive Wakefulness Syndrome (VS/UWS), so the benefit appears limited to those already showing some signs of minimal consciousness.