European Academy of Neurology Guideline on the Diagnosis of Coma and Other Disorders of Consciousness
European Journal of Neurology
Kondziella, D., Bender, A., et al. (2020).
European Journal of Neurology, 27(5), 741-756.
<div>This guideline provides recommendations regarding the examination of coma and other disorders of consciousness (DoC) in patients with acquired brain injury (ABI). This summary highlights recommendations within the scope of speech-language pathology.</div>
European Academy of Neurology
<div>When conducting a clinical examination of consciousness in patients with ABI, clinicians should:</div>
<div>
<ul>
<li>passively open the eyes of patients who lack spontaneous or stimulated eye-opening to assess for signs of voluntary eye movements (Very Low Evidence; Strong Recommendation);</li>
<li>use a mirror to assess visual pursuit (Low Evidence; Strong Recommendation);</li>
<li>observe and document spontaneous motor behavior and automatic motor responses (Very Low Evidence; Weak Recommendation);</li>
<li>classify the level of consciousness using the Coma Recovery Scale-Revised (CSR-R; Moderate Evidence; Strong Recommendation);</li>
<li>never classify consciousness level based on an isolated evaluation and should repeat behavioral assessments in DoC patients (Low Evidence; Strong Recommendation);</li>
<li>use the Full Outline of Unresponsiveness (FOUR) score instead of the Glasgow Coma Scale (GCS) to assess consciousness in intensive care unit (ICU) patients (Moderate Evidence; Strong Recommendation);</li>
<li>regularly monitor for signs of discomfort using the Nociception Coma Scale-Revised (Very Low Evidence; Weak Recommendation); and</li>
<li>not use the Confusion Assessment Method for the ICU (CAM-ICU) in DoC patients in the ICU (Very Low Evidence; Weak Recommendation).</li>
</ul>
</div>
