Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment
By C. Schnakers, Audrey Vanhaudenhuyse, J. Giacino, M. Ventura, Melanie Boly, Steve Majerus, Gustave Moonen, Steven Laureys. BMC Neurology, 2009
1,241 citations recorded by the source corpus.
BackgroundPreviously published studies have reported that up to 43% of patients with disorders of consciousness are erroneously assigned a diagnosis of vegetative state (VS). However, no recent studies have investigated the accuracy of this grave clinical diagnosis. In this study, we compared consensus-based diagnoses of VS and MCS to those based on a well-established standardized neurobehavioral rating scale, the JFK Coma Recovery Scale-Revised (CRS-R).MethodsWe prospectively followed 103 patients (55 ± 19 years) with mixed etiologies and compared the clinical consensus diagnosis provided by the physician on the basis of the medical staff's daily observations to diagnoses derived from CRS-R assessments performed by research staff. All patients were assigned a diagnosis of 'VS', 'MCS' or 'uncertain diagnosis.'ResultsOf the 44 patients diagnosed with VS based on the clinical consensus of the medical team, 18 (41%) were found to be in MCS following standardized assessment with the CRS-R. In the 41 patients with a consensus diagnosis of MCS, 4 (10%) had emerged from MCS, according to the CRS-R. We also found that the majority of patients assigned an uncertain diagnosis by clinical consensus (89%) were in MCS based on CRS-R findings.ConclusionDespite the importance of diagnostic accuracy, the rate of misdiagnosis of VS has not substantially changed in the past 15 years. Standardized neurobehavioral assessment is a more sensitive means of establishing differential diagnosis in patients with disorders of consciousness when compared to diagnoses determined by clinical consensus.
Subfields: Emergency Medicine, Epidemiology, Psychiatry and Mental health
View Paper: https://www.semanticscholar.org/paper/033abc3f511600cc06ba8d0fb111437c84c1fd7b
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Citations in the corpus
- Unresponsive wakefulness syndrome: a new name for the vegetative state or apallic syndrome (2010, background): “A very recent study, however, confirmed this unacceptably high rate of diagnostic error [22].”
- Signature of consciousness in the dynamics of resting-state brain activity (2015, background): “Detecting residual consciousness in patients remains a difficult clinical problem, as it has been determined that as many as 40% of locked-in syndrome patients (who are fully conscious) initially fail to be detected, even in experienced clinical centers (48), and some patients in an apparent VS may ”
- Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients. (2010, background): “A particular problem in patients with disorders of consciousness is that the clinical diagnosis is very challenging at the bedside, and several studies have reported high rates of misdiagnosis , reaching up to 40% (Majerus et al., 2005; Schnakers et al., 2009).”
- From unresponsive wakefulness to minimally conscious PLUS and functional locked-in syndromes: recent advances in our understanding of disorders of consciousness (2011, background): “However, patients with disorders of consciousness are not uniformly hopeless [16, 17] and increasing evidence from clinical [18] and neuroimaging studies (e.”
- Distinct Spectral Profiles of Awake Resting EEG in Disorders of Consciousness: The Role of Frequency and Topography of Oscillations (2022, methodology): “The repeatedly observed high rate of misdiagnosis of UWS (Childs et al. 1993; Schnakers et al 2009; Forgacs et al. 2014) only emphasizes the need for improved diagnostic protocols.”