Implementing an Advanced Care Pathway for Individuals with Disorders of Consciousness in Acute Care: A Retrospective Cohort Study

Background/Objectives: Early identification of disorders of consciousness (DoC) in acute care using standardized assessments may be linked to improved functional recovery, discharge disposition, and levels of consciousness (LoC) on the DoC spectrum. The impact of serial Coma Recovery Scale Revised (CRS-R) assessment and therapy exposure on improving LoC in acute care remains poorly understood. The objective of this study was to examine the association between serial CRS-R assessments, therapy exposure, discharge disposition and changes in LoC among patients with DoC. Methods: A retrospective cohort study included adult patients with severe acquired brain injury (sABI) evaluated and treated in an acute care setting between 2024 and 2026. Primary outcomes were changes in LoC category and discharge disposition. Results: Thirty-nine (39) individuals were included; most were in an unresponsive wakefulness state (UWS) at baseline (68%, n=25), male (74%, n=29), and with non-traumatic sABI diagnosis (72%, n=28). At discharge, 23% (n=9) patients emerged from minimally conscious states (eMCS). Therapy exposure was not significantly associated with changes in LoC. Increased time since therapy initiation was associated with higher odds of improving LOC (OR =4.95, p<0.05), while longer length of stay was associated with decreased odds (8% per day) of improvement (OR= 0.92, p<0.05). Final discharge recommendations were not significantly associated with age (p=0.5) or sex (p=0.7) however, etiology was significantly associated (p=0.046) with individuals with TBI etiologies more likely to have recommendations of inpatient rehabilitation. Discharge LoC (p=0.024) but not admission LoC (p=0.40) was associated with discharge disposition. Conclusions: Serial assessment in acute care for patients with DoC may provide important prognostic information to guide discharge planning.