Category: Brain Injury; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : To establish the efficacy of utilizing the Coma Recovery Scale-Revised (CRS-R) in the acute care setting in order to demonstrate rehab potential in patients with acquired brain injury following polytrauma.
Design : Retrospective case series
Setting : surgical trauma intensive care unit (STICU) within university affilitated Level 1 Trauma center
Participants (or Animals, Specimens, Cadavers) : population based sample of 6 patients (5 males, 1 female, aged 16-47) admitted to STICU with diagnosis of acquired brain injury due to polytrauma with at least 1 CRS-R score documented in the electronic medical record (EMR) over a 3 month period.
Interventions : not applicable
Main Outcome Measure(s) : 1. CRS-R scores
2. Discharge Destination
Results : All of the patients included in this case series required placement in a post-acute care setting. Of 6 patients, 4 progressed to discharge destination of rehab with CRS-R scores > 10 prior to discharge to rehab setting. 1 went to LTACH with score of 9/23 and 1 went to SNF with score of 11/23.
Conclusions : Activity tolerance and participation with therapy are two key indicators for guiding disposition recommendation. A higher score on the CRS-R at initial assessment or an improvement at reassessment was an important indicator that patients would likely be successful inpatient rehab candidates. These results are similar to other studies, however cut-off scores require careful consideration of other factors including medial complexity and social supports also playing a role in discharge destination. Ultimately the CRS-R is a valuable outcome measure to demonstrate rehab potential in patients with traumatic brain injury due to polytrauma when utilized early in the recovery process.