Table 1.
Assessment scales overview.
| Scale | Behavioral content | Standardized administration and scoring | Content validity aspen criteria | Diagnostic validity | Prognostic validity | Public domain | Estimate time require (minutes) |
|---|---|---|---|---|---|---|---|
| CRS-S (26) | Auditory, visual, motor, oral, communication, arousal | Acceptable | Excellent | Unproven (class IV) |
Unproven (not studied) |
YES | 25 |
| SMART (27) | Auditory, vision, tactile, olfactory, gustatory, wakefulness, motor, communication | Acceptable | Good | Unproven (not studied) |
Unproven (class IV) |
NO | 60+ |
| WNSSP (28) | Visual, tactile, olfactory, arousal/attention, auditory, expressive communication | Acceptable | Good | Unproven (not studied) |
Unproven (class IV) |
YES | 45 |
| SSAM (29) | Auditory, vision, tactile, olfactory, gustatory, eye-opening, motor, vocalization | Acceptable | Good | Unproven (not studied) |
Unproven (not studied) |
YES | 30 |
| WHIM (30) | Basic behaviors, social/communication, attention/cognitive, orientation/memory | Acceptable | Good | Unproven (not studied) |
Unproven (not studied) |
NO | 30–120 |
| DOCS (31) | Auditory, visual, tactile, sensory, swallowing, olfactory | Acceptable | Acceptable | Unproven (not studied) |
Unproven (class IV) |
YES | 45 |
| FOUR (32) | Eye response, motor response, respiration, brainstem reflexes | Not acceptable | Unacceptable | Unproven (class IV) |
Probably predictive (class I) |
YES | 10 |
| CNC (33) | Visual, auditory, command following, threat response, olfactory, tactile, pain, vocalization | Acceptable | Acceptable | Unproven (not studied) |
Unproven (class IV) |
YES | 10 |
| STAR (34) | Visual, auditory, motor, communication, emotion | Acceptable | Good | Unproven (not studied) |
Unproven (not studied) |
NO | 6–23 |
CRS-R, Coma recovery scale-revised; SMART, Sensory modal assessment rehabilitation technique; WNSSP, Western neuro stimulation profile; SSAM, Sensory stimulation assessment measure; WHIM, Wessex head injury; DOCS, Disorders of consciousness scale matrix.
Levels of evidence for diagnostic studies: Class I, cohort survey with prospective data collection, includes a broad spectrum of people at risk of developing the outcome of interest, employs objective outcome assessment, inclusion criteria are well-defined, and at least 80% of people enrolled have the risk factor and the outcome measure; Class II, cohort study with retrospective data collection or case-control study, includes a broad spectrum of people with and without the risk factor and the outcome, and the risk factor and outcome are determined objectively and independently; Class III, cohort or case-control studies that include a narrow spectrum of patients with or without the disease in which the diagnostic test result and disease status are determined objectively and independently or by different investigations; Class IV, studies that do not include people suspected or known to have or not have the disease, the reference standard is undefined or not independent, and there are no calculable measures of diagnostic accuracy or precision. For further information about evidence classification, the interested reader is referred to the American Academy of Neurology Guideline Process Manual (35).