# Clinical Validation of the SECONDs Tool for Evaluating Disorders of Consciousness in Argentina

## TL;DR

The study validates a faster and easier tool for assessing disorders of consciousness in Argentina.

## Contribution

The study provides clinical validation of the Argentine adaptation of the SECONDs tool for evaluating disorders of consciousness.

## Key findings

- The SECONDs showed excellent intra-rater and inter-rater reliability.
- The SECONDs demonstrated strong concurrent validity with the CRS-R.
- The SECONDs reduced administration time compared to the CRS-R.

## Abstract

Background: The Coma Recovery Scale–Revised (CRS-R) is the gold standard for diagnosing chronic disorders of consciousness (DoC); however, its clinical utility is limited by lengthy administration and the need for specialized training. The Simplified Evaluation of Disorders of Consciousness (SECONDs) provides a faster and more user-friendly alternative. Objective: This study aims to evaluate the validity and reliability of the Argentine adaptation of the SECONDs scale in adults with chronic DoC due to acquired brain injury. Methods: Twenty-nine patients were evaluated over two consecutive days by three blinded raters. On day one, rater A administered the SECONDs (A1) and rater B administered the CRS-R (B) to assess concurrent validity. On day two, rater A repeated the SECONDs (A2), and rater C performed an additional SECONDs assessment (C), permitting evaluation of intra-rater (A1 vs. A2) and inter-rater (A vs. C) reliability. Results: The SECONDs demonstrated excellent intra-rater (ICC = 0.98) and inter-rater (ICC = 0.86) reliability. Concurrent validity with the CRS-R was strong (r = 0.73, p < 0.001). Diagnostic agreement was high between A1 and B (κ = 0.75) and between both A1-A2 and A1-C (κ = 0.82). The median administration time was significantly shorter for the SECONDs (10 vs. 15 min; p < 0.001). Conclusion: The Argentine SECONDs is a valid, reliable, and efficient tool for the clinical assessment of DoC patients in rehabilitation settings.