Domain-specific recovery profiles of consciousness after surgically treated intracerebral hemorrhage: A multicenter analysis of the six CRS-R subscales.

Authors

Kaiwen Wang, Yinghe Feng, Kaige Zheng, Qingyuan Liu, Shuo Wang, Xianzeng Tong

Published in

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. Volume 153. Pages 112222. Aug 07, 2026. Epub Aug 07, 2026.

Abstract

Recovery of consciousness after surgically treated spontaneous intracerebral hemorrhage (sICH) is heterogeneous, but longitudinal domain-specific patterns remain insufficiently characterized. We examined recovery across the six Coma Recovery Scale-Revised (CRS-R) subscales during the first postoperative year.
This secondary analysis of the prospective multicenter CRISIH registry included 744 surviving, assessable patients who underwent surgery for sICH at 21 Chinese centers between November 2019 and December 2024, from 810 eligible patients (37 deaths, 29 losses to follow-up). CRS-R subscales were assessed at 1, 3, 6, and 12 months (17,856 domain-time observations). The estimand was recovery conditional on survival. Proportion-of-maximum scores were analyzed with linear mixed-effects models, with ordinal cumulative-link and binomial mixed models as robustness checks; emergence was evaluated with mixed logistic and competing-risk models.
CRS-R trajectories differed across domains (domain-by-time likelihood-ratio test χ² = 477.9, df = 15, p < 0.001; ordinal and binomial analyses concordant). Auditory, visual, and arousal scores were high at month 1 and showed small net decreases by 12 months (-0.026 to - 0.038; <0.2 raw point; within measurement error). Communication and motor scores increased most (+0.103 and + 0.062; both p < 0.001); oromotor/verbal was unchanged (+0.003; p = 0.65). Functional communication rose from 34.8% to 52.0%; functional object use did not (24.5% to 23.1%). Emergence from MCS increased from 52.2% to 67.1% (competing-risk cumulative incidence ∼ 0.67 at 12 months).
Among survivors after sICH surgery, CRS-R recovery was domain-specific: communication and motor domains accounted for most measurable gains, whereas auditory, visual, and arousal domains were near ceiling by month 1. These findings support subscale-level CRS-R monitoring.

PMID:
42566841
Bibliographic data and abstract were imported from PubMed on 08 Aug 2026.

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