[en] BACKGROUND: Previously 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). METHODS: We 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.' RESULTS: Of 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. CONCLUSION: Despite 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.
Disciplines :
Neurology
Author, co-author :
Schnakers, Caroline ; Université de Liège - ULiège > Coma group > Centre de recherches du cyclotron
Vanhaudenhuyse, Audrey ; Université de Liège - ULiège > Coma group > Centre de recherches du cyclotron
Giacino, Joseph
Ventura, Manfredi
Boly, Mélanie ; Université de Liège - ULiège > Centre de Recherches du Cyclotron - Coma group -Département des sciences cliniques > Neurologie
Majerus, Steve ; Université de Liège - ULiège > Département des sciences cognitives > Psychopathologie cognitive
Moonen, Gustave ; Centre Hospitalier Universitaire de Liège - CHU > Neurologie Sart Tilman
Laureys, Steven ; Université de Liège - ULiège > Coma group > Centre de recherches du cyclotron - Département des sciences cliniques
Language :
English
Title :
Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment.
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