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  • Open Access

A comparison of a behavioural assessment tool and electrophysiological measures of recovery from coma

  • 1,
  • 1 and
  • 1
Critical Care20048 (Suppl 1) :P313

https://doi.org/10.1186/cc2780

  • Published:

Keywords

  • Good Sensitivity
  • Complete Recovery
  • Subtle Change
  • Vegetative State
  • Conscious State

The Wessex Head Injury Matrix (WHIM) [1] is one of the rare behavioural scales that have been designed to follow the recovery of head-injured patients throughout the whole spectrum of altered states of consciousness, from exit of coma to complete recovery. In this study, we explored the validity of the WHIM in relation to other behavioural assessment tools – Glasgow–Liège Coma Scale (GLS) [2], Coma-Near Coma scale (CNC) [3], Western Neuro Sensory Stimulation Profile (WNSSP) [4] – as well as in relation to the Bi-Spectral Index (BIS), derived from electroencephalographic measures. Twenty-nine brain-injured comatose patients (aged 21–83 years) were followed longitudinally with these behavioural and electrophysiological measures. Overall, the evolution of the scores on the WHIM correlated significantly with the evolution of scores obtained by the GLS (r = 0.88; P < 0.01), the CNC (r = -0.8; P < 0.01), the WNSSP (r = 0.87; P < 0.01), as well as with the BIS measure (r = 0.58; P < 0.01). Relative to the GLS, CNC and WNSSP, the WHIM showed a particularly good sensitivity for documenting subtle changes in recovery for patients in a minimally conscious state. The BIS index globally evolved in parallel to the behavioural scales. However, it showed a very bad sensitivity as many patients in a coma or a vegetative state presented BIS scores that were as high as those observed for patients that had regained normal consciousness. The results confirm the usefulness of the WHIM, especially for the assessment of minimally conscious patients. However, even if a global relation is observed with behavioural scales, the validity of electrophysiological measures such as the BIS index is unsatisfactory for the assessment of altered states of consciousness.

Authors’ Affiliations

(1)
University of Liège (ULG), Belgium

References

  1. Shiel A, Horn SA, Wilson BA, Watson MJ, Campbell MJ, McLellan DL: The Wessex Head Injury Matrix (WHIM) main scale: a preliminary report on a scale to assess and monitor patient recovery after severe head injury. Clin Rehabil 2000, 14: 408-416.View ArticlePubMedGoogle Scholar
  2. Born JD, Hans P, Dexters G, et al.: Practical assessment of brain dysfunction in severe head trauma. Neurochirurgie 1982, 28: 1-7.PubMedGoogle Scholar
  3. Rappaport M, Dougherty AM, Kelting DL: Evaluation of coma and vegetative states. Arch Phys Med Rehabil 1992, 73: 628-634.PubMedGoogle Scholar
  4. Ansell BJ, Keenan JE: The Western Neuro Sensory Stimulation Profile: a tool for assessing slow-to-recover head-injured patients. Arch Phys Med Rehabil 1989, 70: 104-108.PubMedGoogle Scholar

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