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

  title={Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment},
  author={Caroline Schnakers and Audrey Vanhaudenhuyse and Joseph T. Giacino and Manfredi Ventura and M{\'e}lanie Boly and Steve Majerus and Gustave Moonen and Steven Laureys},
  journal={BMC Neurology},
  pages={35 - 35}
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… 

The misdiagnosis of prolonged disorders of consciousness by a clinical consensus compared with repeated coma-recovery scale-revised assessment

It was found that 24.7% of patients with clinical UWS were actually in MCS after a single CRS-R behavior evaluation, while the repeated C RS-R evaluation results showed that the proportion of misdiagnosis of MCS was 38.2%.

Assessment of patients with disorder of consciousness: do different Coma Recovery Scale scoring correlate with different settings?

It is demonstrated how the presence of caregivers can positively affect behavioural assessments of persons with DOC, thus contributing to the definition of the optimal setting for behavioural evaluation of patients, to decrease misdiagnosis rates.

Misdiagnosis rate of the prolonged disorders of consciousness on a clinical consensus compared with a repeated Coma-Recovery Scale-Revised assessment

Clinicians should be aware of the importance of the bedside CRS-R behavior assessment and should apply the C RS-R tool to daily procedures.

Neurobehavioural assessment and diagnosis in disorders of consciousness: a preliminary study of the Sensory Tool to Assess Responsiveness (STAR)

The reliability and validity of the STAR is demonstrated, showing its appropriateness for clinical use and future longitudinal studies and research into the STAR's applicability in long-stay rehabilitation are indicated.

The vegetative and minimally conscious states: a review of the literature and preliminary survey of prevalence in Ireland

An international agreement on standard behavioural assessment is recommended to enable greater consistency in diagnosis and prognostication, as well as improved accuracy of epidemiological data.

Clinical assessment of patients with chronic disorders of consciousness by different medical specialists

The level of inter-expert reliability was poor in all three specializations when using clinical examination to determine the degree of impaired consciousness in patients with CDC, and a scale with detailed criteria is needed to enable medical specialists to determine a patients rehabilitation potential and predict disease progression more accurately.

Wisdom of the caregivers: pooling individual subjective reports to diagnose states of consciousness in brain-injured patients, a monocentric prospective study

Together with the CRS-R as well as with brain imaging, DoC-feeling might improve diagnostic and prognostic accuracy of patients with DoC.

Vegetative state, minimally conscious state, akinetic mutism and Parkinsonism as a continuum of recovery from disorders of consciousness: an exploratory and preliminary study.

The emotional stimulation provided by significant others (caregivers) during administration of DOC evaluation scales may improve the assessment of responsiveness.



The minimally conscious state: Definition and diagnostic criteria

MCS is characterized by inconsistent but clearly discernible behavioral evidence of consciousness and can be distinguished from coma and VS by documenting the presence of specific behavioral features not found in either of these conditions.

Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit

The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made from a bedside assessment; accurate diagnosis is possible but requires the skills of a multidisciplinary team experienced in the management of people with complex disabilities.

The vegetative and minimally conscious states: consensus-based criteria for establishing diagnosis and prognosis.

The practice recommendations proposed by expert panels charged with developing consensus-based definitions and diagnostic criteria for disorders of consciousness are summarized and their implications for existing and future interventions are discussed.

Accuracy of diagnosis of persistent vegetative state

Inaccurate diagnosis was more likely if the injury was more than 3 months before admission and the etiology of injury was trauma (48%).

Does the FOUR score correctly diagnose the vegetative and minimally conscious states?

The ability of the newly proposed FOUR scale to correctly diagnose the vegetative state in an acute (intensive care and neurology ward) and chronic (neurorehabilitation) setting was tested.

The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility.

Medical aspects of the persistent vegetative state (1).

This consensus statement of the Multi-Society Task Force summarizes current knowledge of the medical aspects of the persistent vegetative state in adults and children. The vegetative state is a

Thirty years of the vegetative state: clinical, ethical and legal problems.

A French validation study of the Coma Recovery Scale-Revised (CRS-R)

The results show that the French version of the CRS-R is a valid and sensitive scale which can be used in severely brain damaged patients by all members of the medical staff.

Behavioral evaluation of consciousness in severe brain damage.