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

ObjectiveThis 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.MethodsWe 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.ResultsThe 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.ConclusionsThe two-dimensionally reduced representation of CRS-R scores maintains diagnostic accuracy while improving DoC classification. The four-quadrant model enables personalized interventions.Trial registrationOur study has been verified by the Chinese Clinical Trial Registry with the registration number: ChiCTR2400085855, and the registration date is June 19, 2024.