Research article

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

Caroline Schnakers¹ , Audrey Vanhaudenhuyse¹ , Joseph Giacino² , Manfredi Ventura³ , Melanie Boly^1,4 , Steve Majerus⁵ , Gustave Moonen⁴ and Steven Laureys^1,4

¹  Coma Science Group, Cyclotron Research Center, University of Liege, Belgium

²  New Jersey Neuroscience Institute, Edison, NJ, USA

³  CTR Neurorehabilitation Centre, Université Libre de Bruxelles, Brussels, Belgium

⁴  Department of Neurology, Centre Hospitalier Universitaire Sart Tilman, University of Liege, Belgium

⁵  Department of Cognitive Sciences, Experimental Psychology and Cognitive Neuroscience Research Unit-URPENC, University of Liege, Belgium

author email corresponding author email

BMC Neurology 2009, 9:35doi:10.1186/1471-2377-9-35

Published:	21 July 2009

Abstract

Background

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).

Methods

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.'

Results

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.

Conclusion

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.