Simplified evaluation of CONsciousness disorders (SECONDs) in individuals with severe brain injury: A validation study

• Published in: Annals of physical and rehabilitation medicine Vol. 64; no. 5; p. 101432
• Main Authors: Aubinet, Charlène, Cassol, Helena, Bodart, Olivier, Sanz, Leandro R.D., Wannez, Sarah, Martial, Charlotte, Thibaut, Aurore, Martens, Géraldine, Carrière, Manon, Gosseries, Olivia, Laureys, Steven, Chatelle, Camille
• Format: Journal Article Web Resource
• Language: English
• Published: Elsevier Masson SAS 01.09.2021; Elsevier Masson
• Subjects: Coma; Disorders of consciousness; Human health sciences; Neurologie; Neurology; Rehabilitation; Sciences de la santé humaine; Trauma; Coma; Rehabilitation; Trauma; Disorders of consciousness
• ISSN: 1877-0657; 1877-0665; 1877-0665
• DOI: 10.1016/j.rehab.2020.09.001

•The diagnostic of disorders of consciousness is challenging but crucial.•The SECONDs is a quick behavioral tool for assessing consciousness.•The scale is easy to use in brain-injured patients in daily routine clinical practice.•It has good reliability and validity as compared with the most recommended scale. The Coma Recovery Scale-Revised (CRS-R) is the gold standard to assess severely brain-injured patients with prolonged disorders of consciousness (DoC). However, the amount of time needed to complete this examination may limit its use in clinical settings. Objective. We aimed to validate a new faster tool to assess consciousness in individuals with DoC. This prospective validation study introduces the Simplified Evaluation of CONsciousness Disorders (SECONDs), a tool composed of 8 items: arousal, localization to pain, visual fixation, visual pursuit, oriented behaviors, command-following, and communication (both intentional and functional). A total of 57 individuals with DoC were assessed on 2 consecutive days by 3 blinded examiners: one CRS-R and one SECONDs were performed on 1 day, whereas 2 SECONDs were performed on the other day. A Mann-Whitney U test was used to compare the duration of administration of the SECONDs versus the CRS-R, and weighted Fleiss’ kappa coefficients were used to assess inter-/intra-rater reliability as well as concurrent validity. In the 57 participants, the SECONDs was about 2.5 times faster to administer than the CRS-R. The comparison of the CRS-R versus the SECONDs on the same day or the best of the 3 SECONDs led to “substantial” or “almost perfect” agreement (kappa coefficients ranging from 0.78 to 0.85). Intra-/inter-rater reliability also showed almost perfect agreement (kappa coefficients from 0.85 to 0.91 and 0.82 to 0.85, respectively). The SECONDs appears to be a fast, reliable and easy-to-use scale to diagnose DoC and may be a good alternative to other scales in clinical settings where time constraints preclude a more thorough assessment.