Open Access Highly Accessed 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 Boly14, Steve Majerus5, Gustave Moonen4 and Steven Laureys14*

Author Affiliations

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

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

Published: 21 July 2009



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).


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.'


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.


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.