Journal Article


How often is the diagnosis of the permanent vegetative state incorrect? : A review of the evidence

Abstract

Background. Some research suggests that 40% of people in the vegetative state are misdiagnosed. This review investigates the frequency, nature and causes of reported misdiagnosis of patients in the vegetative state, focusing on the nature of the error. Method. A systematic review of all relevant literature, using references from key papers identified. Data summarised in tables. Results. Five clinical studies of rate of misdiagnosis in practice were identified, encompassing 236 patients in the vegetative state of whom 80 (34%) were reclassified has having some awareness, often minimal. The studies often included patients in the recovery phase after acute injury, and were poorly reported. Five systematic reviews of signs and technologically-based neurophysiological tests were identified, and they showed that most studies were small, lacked accurate or important details, and were subject to bias. Studies were not replicated. Many signs and tests did not differ between people in the vegetative and minimally conscious state, and those that did were unable to diagnose an individual patient. The few single case reports suggest that failure to ensure an accurate diagnosis of the underlying neurological damage and dysfunction could, rarely, lead to significant misdiagnosis usually in patients who had brain-stem damage with little thalamic or cortical damage. Conclusions. Significant misdiagnosis of awareness, with an apparently ‘vegetative’ patient having good awareness, is rare. Careful neurological assessment of the cause and routine measurement of awareness using the Coma Recovery Scale- Revised should further reduce mistakes.

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Authors

Wade, Derick

Oxford Brookes departments

Faculty of Health and Life Sciences

Dates

Year of publication: 2018
Date of RADAR deposit: 2018-01-16


Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License


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This RADAR resource is the Accepted Manuscript of How often is the diagnosis of the permanent vegetative state incorrect? : A review of the evidence
This RADAR resource is the Accepted Manuscript of How often is the diagnosis of the permanent vegetative state incorrect? : A review of the evidence

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