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Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment

By Majerus Steve, Boly Melanie, Ventura Manfredi, Giacino Joseph, Vanhaudenhuyse Audrey, Schnakers Caroline, Moonen Gustave and Laureys Steven

Abstract

<p>Abstract</p> <p>Background</p> <p>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).</p> <p>Methods</p> <p>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.'</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p

Topics: Neurology. Diseases of the nervous system, RC346-429, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571, Internal medicine, RC31-1245, Medicine, R, DOAJ:Neurology, DOAJ:Medicine (General), DOAJ:Health Sciences
Publisher: BioMed Central
Year: 2009
DOI identifier: 10.1186/1471-2377-9-35
OAI identifier: oai:doaj.org/article:2898656cb1f84fb5b7cf9f371285363e
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