Reference : Diagnostic accuracy of the vegetative and minimally conscious state: clinical consens...
Scientific journals : Article
Human health sciences : Neurology
Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment.
Schnakers, Caroline mailto [Université de Liège - ULiège > Coma group > Centre de recherches du cyclotron > > >]
Vanhaudenhuyse, Audrey mailto [Université de Liège - ULiège > Coma group > Centre de recherches du cyclotron > > >]
Giacino, Joseph [> > > >]
Ventura, Manfredi [> > > >]
Boly, Mélanie mailto [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 mailto [Université de Liège - ULiège > Coma group > Centre de recherches du cyclotron - Département des sciences cliniques > > >]
BMC Neurology
BioMed Central
Yes (verified by ORBi)
[en] Adult ; Aged ; Aged, 80 and over ; Diagnosis, Differential ; Diagnostic Errors ; Female ; Humans ; Male ; Middle Aged ; Neurologic Examination ; Persistent Vegetative State/diagnosis
[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.
Fonds de la Recherche Scientifique (Communauté française de Belgique) - F.R.S.-FNRS

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