PM&R
Volume 1, Issue 2 , Pages 152-161, February 2009

Predictive Value of the Disorders of Consciousness Scale (DOCS)

  • Theresa Louise-Bender Pape, Dr.PH, MA

      Affiliations

    • Department of Veterans Affairs (VA), Research Service and the Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital, Research Service (151H), PO Box 5000, Hines, IL 60141; Marianjoy Rehabilitation Hospital, Wheaton, IL; and Northwestern University Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation, Office of Medical Education (1574), Chicago, IL.⁎
    • Corresponding Author InformationAddress correspondence to: T.L.-B.P.
    • ,
  • Charlene Tang, PhD, MPH, MD

      Affiliations

    • The Department of Veterans Affairs (VA), The Cooperative Studies Program, Edward Hines Jr. VA Hospital, Hines, IL⁎
    • ,
  • Ann Guernon, MS

      Affiliations

    • Marianjoy Rehabilitation Hospital, Wheaton, IL⁎
    • ,
  • Sandra Lundgren, PhD

      Affiliations

    • Minneapolis VA Medical Center, Psychology Service, Minneapolis, MN⁎
    • ,
  • Melanie Blahnik, PhD

      Affiliations

    • Minneapolis VA Medical Center, Polytrauma Rehabilitation Program, Minneapolis, MN⁎
    • ,
  • Yongliang Wei, MS

      Affiliations

    • The Department of Veterans Affairs (VA), The Cooperative Studies Program, Edward Hines Jr. VA Hospital, Hines, IL⁎
    • ,
  • Melanie Querubin, MD

      Affiliations

    • Department of Veterans Affairs (VA), Edward Hines Jr. VA Hospital, Physical Medicine and Rehabilitation Service, Hines, IL⁎
    • ,
  • Felise Zollman, MD

      Affiliations

    • Rehabilitation Institute of Chicago, Chicago, IL⁎
    • ,
  • Ileana Soneru, MD

      Affiliations

    • Department of Veterans Affairs (VA), Edward Hines Jr. VA Hospital, Physical Medicine and Rehabilitation Service, Hines, IL⁎

Received 19 August 2008; accepted 5 November 2008.

Objective

To examine the predictive validity of measures of neurobehavioral change derived from the Disorders of Consciousness Scale (DOCS) for predicting return to consciousness 4, 8, and 12 months after severe brain injury (BI).

Design

Prospective observational predictive validity study

Setting

Inpatient rehabilitation hospitals and postrehabilitation residence

Participants

A total of 113 persons with a mean age of 38 ± 17.8 years who were unconscious for >28 days consecutively after severe BI; 73% (83/113) with traumatic BI and 27% (30/113) with other BI.

Independent Variables

Baseline DOCS, DOCS average, change from baseline DOCS to subsequent DOCS (DOCS2, DOCS3, DOCS4, DOCS5, DOCS6), and injury type (traumatic BI vs. other BI)

Main Outcome Measure

Time to consciousness at 4, 8, and 12 months after injury

Results

When controlling for injury type, the DOCS average as well as DOCS change between the first and second DOCS (DOCS1-2), first and fifth DOCS (DOCS1-5) and first and last DOCS (DOCStotalchg) significantly (P ≤ .05) contributed to predicting recovery and lack of recovery of consciousness at 4, 8, and/or 12 months after injury. DOCS1-5 manifested the most balanced accuracy in predictions, where predicting recovery of consciousness is accurate 87% of the time and predicting lack of recovery of consciousness is accurate 88% of the time.

Conclusion

For persons with prolonged disorders of consciousness, the findings indicate that evidence-based prognostication for individual patients is possible. The implications for research are that the DOCS can be used as a meaningful, reliable, and valid primary outcome to measure treatment effects in clinical trials. The evidence indicates further that DOCS measures merit inclusion in future research that aims to develop multivariate prognostication models.

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 
  • ⁎ Disclosure: nothing to disclose
  • ⁎ Disclosure: nothing to disclose
  • ⁎ Disclosure: 8B
  • ⁎ Disclosure: 8B
  • ⁎ Disclosure: nothing to disclose
  • ⁎ Disclosure: nothing to disclose
  • ⁎ Disclosure: 8A

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

 This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development Rehabilitation Research and Development Service and Health Services Research and Development Service through a HSR&D merit grant (Grant No. CCN-07-133); a RR&D advanced research career development award (Grant No. B4951-R); and a RR&D career development transition award (Grant No. B4949N). Funding also was provided by the Nick Kot Charity, nfp. In kind-contributions from Marianjoy Rehabilitation Hospital, the Minneapolis VA Medical Center, the Hines VA Hospital, and the Rehabilitation Institute of Chicago also support the work described in this article. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

PII: S1934-1482(08)00029-4

doi:10.1016/j.pmrj.2008.11.002

PM&R
Volume 1, Issue 2 , Pages 152-161, February 2009

Article Tools