Multi-centered reassessment of CRS-R in disorders of consciousness: a dimensionality reduction study from cognition and motor function

This is the authors' abstract. We don't add key points for this paper.

Objective This study aimed to enhance the Coma Recovery Scale-Revised (CRS-R) for disorders of consciousness (DoC) by developing a two-dimensional model differentiating cognition and motor function. Methods We analyzed 124 DoC patients retrospectively and validated findings using five multicenter datasets ( n = 420). CRS-R subscores were decomposed into Consciousness_x (awareness) and Consciousness_y (arousal/motor function) using Projective Non-negative Matrix Factorization. Logistic regression established diagnostic thresholds, evaluated by accuracy, precision, recall, and F1-score. Results The model achieved high accuracy (0.94), precision (0.92), and recall (0.99). Patients with minimally conscious state (MCS) or emerged MCS showed significantly higher scores than vegetative state (VS) patients ( p < 0.05). The four-quadrant framework revealed distinct clinical profiles: Quadrant I (high awareness/arousal) identified patients for cognitive rehabilitation; Quadrant II (low awareness/high arousal) suggested arousal-enhancing therapies; Quadrant III (low awareness/arousal) indicated VS requiring basic support; Quadrant IV (high awareness/low arousal) highlighted needs for sensorimotor integration. Conclusions The two-dimensionally reduced representation of CRS-R scores maintains diagnostic accuracy while improving DoC classification. The four-quadrant model enables personalized interventions. Trial registration Our study has been verified by the Chinese Clinical Trial Registry with the registration number: ChiCTR2400085855, and the registration date is June 19, 2024.