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

@article{Schnakers2009DiagnosticAO,
  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},
  year={2009},
  volume={9},
  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… 

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References

SHOWING 1-10 OF 24 REFERENCES

The minimally conscious state: Definition and diagnostic criteria

TLDR
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

TLDR
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.

TLDR
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

TLDR
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?

TLDR
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)

TLDR
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.