Standardized Measures > CRSR-FAST

Coma Recovery Scale Revised - For Accelerated Standardized Testing

(CRSR-FAST)

(Bodien & Giacino, 2023)

Administration and Scoring Manual

The CRS-R FAST is an abbreviated version of the full CRS-R designed for the ICU and acute care setting. Rather than profiling all behaviors across six subscales, it assesses only the behaviors that reliably distinguish conscious patients (MCS or eMCS) from unconscious patients (coma or VS/UWS). The output is binary — conscious or not conscious — not a subscale score. This makes it faster and practical for settings where a full CRS-R isn't feasible every session, but a question of consciousness still needs to be answered.

Target Population

Adults with acute traumatic brain injury who are at least 18 years old and not consistently following commands. Validated in the acute ICU setting. Use in the same population as the full CRS-R; ongoing work is examining applicability to non-traumatic DoC populations.

The 5 Main Items

Each main item is scored as present or not present:

  1. Reproducible movement to command (MCS+)

  2. Fixation / visual pursuit (MCS−)

  3. Automatic motor response (MCS−)

  4. Localization to noxious stimulation (MCS−)

  5. Intelligible expression (MCS+)

Items 1 and 5 indicate MCS+ if present. Items 2, 3, and 4 indicate MCS− if present.

The 3 Supplemental Items

Supplemental items are administered only when the main 5 items are not endorsed:

  1. Functional object use (eMCS)

  2. Functional / accurate communication (eMCS)

  3. Non-functional intentional communication (MCS+)

Items Required for Testing

  • Hand mirror (for main items)

  • Two common objects such as a cup, comb, or toothbrush (for supplemental items)

Scoring

The CRS-R FAST does not produce a numbered score. The output is a clinical determination: conscious (any main or supplemental item endorsed) or not conscious (no items endorsed).

The CRS-R FAST produces a binary result — conscious or not conscious. It cannot track within-category progress or profile which specific behaviors are present. If a patient screens conscious, follow up with the full CRS-R to establish a behavioral profile for goal-writing and documentation.

Arousal Facilitation Protocol

Same protocol as the full CRS-R: if the patient's eyes close or behavioral responsiveness stops, administer the arousal facilitation protocol to prolong sustained wakefulness before continuing.

When to Use CRS-R FAST vs. Full CRS-R

Use the CRS-R FAST when your primary question is: Is this patient conscious? — particularly during early ICU admission, when you're screening before a full evaluation, or when time and patient tolerance are limited.

Use the full CRS-R when you need to know which behaviors are present across subscales — for goal-writing, tracking within-MCS progress, formal DoC diagnosis, prognostication conversations with the team, or research documentation. The CRS-R FAST's binary output means you cannot track improvement within a diagnostic category the way you can with subscale scores.

If a patient screens as conscious on the CRS-R FAST, follow up with a full CRS-R to establish the behavioral profile and begin goal-directed treatment planning.

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References

Bodien, Y. G., Vora, I., Barra, A., Chiang, K., Chatelle, C., Goostrey, K., Martens, G., Malone, C., Mello, J., Parlman, K., Ranford, J., Sterling, A., Waters, A. B., Hirschberg, R., Katz, D. I., Mazwi, N., Ni, P., Velmahos, G., Waak, K., … Giacino, J. T. (2023). Feasibility and validity of the Coma Recovery Scale‐Revised for accelerated standardized testing: A practical assessment tool for detecting consciousness in the intensive care unit. Annals of Neurology, 94(5), 919–924. https://doi.org/10.1002/ana.26740