Press release

A study carried out on misdiagnosis in patients with altered states of consciousness shows that 41% of patients in a minimally conscious state are erroneously diagnosed as being in the vegetative state.  In a paper published in BMC Neurology, a team of researchers led by Steven Laureys at the University of Liege (Belgium), in collaboration with Drs Caroline Schnakers and Joseph Giacino at the New Jersey Neuroscience Institute (USA) have demonstrated that standardized neurobehavioral assessment is a more sensitive means of establishing a diagnosis when compared to diagnoses determined by clinical consensus.

The researchers compared clinical consensus-based diagnoses to those based on the standardized Coma Recovery Scale-revised (CRS-R) assessment, a sensitive tool developed by the American team led by Joseph Giacino and validated by Caroline Schnakers to detect any sign of consciousness.

Professor Laureys underlines the importance of what is at stake: « Differentiating a vegetative state from a minimally conscious state is one of the most significant challenges facing clinicians involved in the care of severely brain-damaged patients. Misdiagnosis can indeed have serious consequences, particularly as regards end- o-f life decisions. »

The authors of the study prospectively followed 103 patients with various etiologies and demonstrated that out 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 assessment with the CRS-R.

According to Prof. Laureys, « non-standardized assessments are likely to contribute to vegetative state patients being misdiagnosed. Misdiagnosis is avoided in CRS-R in that it contains items which directly reflect diagnostic criteria for minimally conscious state and standardizes the administration and evaluation of these criteria.

The authors conclude that « this study suggests that the systematic use of a sensitive and standardized behavioral scale can help reduce misdiagnosis or at least limit the uncertainty that is linked to  such a diagnosis. »


Source
« Diagnostic accuracy of the vegetative and minimally conscious state : Clinical consensus versus standardized neurobehavioral assessment», BMC Neurology, Edition 21/07/2009 - http://www.biomedcentral.com/bmcneurol/

Authors
Caroline Schnakers, PhD ; Audrey Vanhaudenhuyse, BS ; Joseph Giacino, PhD ; Manfredi Ventura MD PhD ; Melanie Boly, MD ; Steve Majerus, PhD ; Gustave Moonen, MD, PhD ; Steven Laureys, MD, PhD


Editor's note
Patients in vegetative state show reflex movements only. If capable of more than reflex movements while unable to communicate, the patient is described as being in minimally conscious state. Patients in vegetative state have a poorer medical prognosis than those in minimally conscious state.

Establishing a correct diagnosis is important as far as both end-of-life decisions and therapeutic care are concerned. The team of researchers at the University of Liege indeed recently demonstrated that patients in minimally conscious state feel pain (M. Boly Et al., Lancet Neurology, 2008) and emotions (S. Laureys, Neurology, 2004).