Quality of models of scales of consciousness level, functional state, and general somatic severity in patients with consequences of brain damage in intensive care and rehabilitation department

Abstract

Background. The approach to the use of scales for assessing the level of consciousness, functional and general somatic status for rehabilitation and intensive care units is statistically and clinically insufficiently substantiated.

Aims: development and substantiation of a typical scheme for the clinical use of scales of the level of consciousness, general somatic and functional status of patients with consequences of brain damage of various etiologies.

Methods. A single-center prospective, retrospective study that included 118 patients on 20–50 days after traumatic brain injury, anoxic damage; consequences of acute cerebral circulatory disorders, and neurosurgical operations. In groups of patients who are in a coma, vegetative status, a state of minimal consciousness and a state of clear consciousness, the analysis of the statistical quality of clinical scales was carried out: scales of consciousness: the Glasgow Coma Scale (GCS); FOUR (Full Outline of UnResponsiveness); Coma Recovery Scale-Revised (CRS-R); the Glasgow Outcome Scale (GOS); the Extended Scale of the Glasgow Coma (Glasgow Outcome Scale Extended, GOSE); Rancho Los Amigos scale — scale of consciousness and interaction with the environment (the Rancho Los Amigos scale, RLAS); Functional status scales: DRS (the Disability Rating Scale); modified Rankin Scale mRS; Barthel Activities of Daily Living (ADL) Index; Functional Independence Measure (FIM); Karnovsky Index; Rivermead Mobility Index self-assessment of everyday life opportunities in Merton and Sutton (checklist self-maintenance Merton and Sutton community NHS trust); Scales of General somatic severity: assessment of multi-organ dysfunction on the APACHE II scale (Acute Physiology and Chronic Health Evaluation); APACHE IV scale; SAPS II scale (Simplified Acute Physiology Score); SOFA scale (Sequential Organ Failure Assessment). The functional state of the ANS was recorded using HRV parameters by recording 5-minute RR intervals of the electrocardiogram.

Results. There are 4 groups of patients who are in a state of coma, vegetative status, a state of minimal consciousness and a state of clear consciousness. In 67 patients out of 118 examined (56.8%) after brain and brain damage as a result of TBI, anoxia, stroke, the parameters of ANS functional activity are in the zone of pathological (sympathetic/parasympathetic hyperactivity) values. Manifestations of sympathetic/parasympathetic hyperactivity is progressively reduced from the patients in a coma to patients in clear consciousness.

Conclusions. Various scales of the level of consciousness, functional and general somatic severity of patients with the consequences of brain damage, objectively differ in clinical significance in the gradation of coma–vegetative status–minimal consciousness–clear consciousness.

Keywords

GCS / FOUR / CRS-R / GOS / GOSE / RLAS-R

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RIGHTS & PERMISSIONS

Kiryachkov Y.Y., Petrova M.V., Pryanikov I.V., Kolesov D.L., Parfenov A.L., Bosenko S.A.