International Journal of Neurorehabilitation

ISSN: 2376-0281

Open Access

Bedside Clinical Assessment of Consciousness Level in Patients with Severe Chronic Disorders of Consciousness


Jun Shinoda, Noriko Usami, Yoshitaka Asano and Yuka Ikegame

Conventional medical terms, vegetative state (VS) and minimally conscious state (MCS), for representing consciousness level of chronic disorders of consciousness (DOC) have two problems to use at bedside. One is a nosological issue, and the other is an issue related to scientific usability for clinical assessment. A three-by-two-graded classification, the chronic DOC scale (CDOCS), without any nosologically unfavorable and equivocal words, was established. The consciousness level of 143 patients with severe chronic DOC both at the time of admission and 24 months after the admission were determined using the VS/MCS classification and CDOCS, and the differences of the results of evaluation for improvement between these were assessed. Forty-seven (33%) and 63 (44%) patients were determined as having improved 24 months after admission on the VS/MCS classification and CDOCS, respectively. There was a significant difference in the percentages between these grading systems (p<0.0001). The advantages of CDOCS are that it makes it possible to avoid using uncomfortable and ambiguous terms and that it is superior for evaluating nuanced consciousness level. We recommend the use of CDOCS for bedside assessment of consciousness level in patients with severe chronic DOC as a supplement for the conventional descriptions.


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