Misdiagnosis of disorders of consciousness still commonplace

Jul 21, 2009

A sixteen-month study of consensus-based diagnosis of patients with disorders of consciousness has shown that 41% of cases of minimally conscious state (MCS) were misdiagnosed as vegetative state (VS), a condition associated with a much lower chance of recovery. Researchers writing in the open access journal BMC Neurology have demonstrated that standardized neurobehavioral assessment is more sensitive than diagnoses determined by clinical consensus.

Steven Laureys, from the University of Liege, Belgium, worked with a team of researchers, including Caroline Schnakers and Joseph Giacino, to compare consensus-based diagnoses of VS and MCS to those based on the JFK Coma Recovery Scale-Revised (CRS-R), a well-established standardized neurobehavioral rating scale. Laureys said, "Differentiating the vegetative from the minimally conscious state is often one of the most challenging tasks facing clinicians involved in the care of patients with disorders of consciousness. Misdiagnosis can lead to grave consequences, especially in end-of-life decision-making".

The researchers prospectively followed 103 patients 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 the CRS-R. They found that 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. According to Laureys, "It is likely that the examiners' reliance on unstructured bedside observations contributed to the high rate of misdiagnosis of VS patients. Unlike traditional bedside assessment, the CRS-R guards against misdiagnosis by incorporating items that directly reflect the existing for MCS, and by operationalizing scoring criteria for the identification of behaviors associated with consciousness".

The researchers conclude, "The results of this study suggest that the systematic use of a sensitive standardized neurobehavioral assessment scale may help decrease diagnostic error and limit diagnostic uncertainty".

More information: Diagnostic accuracy of the vegetative and minimally conscious state: Clinical consensus versus standardized neurobehavioral assessment, Caroline Schnakers, Audrey Vanhaudenhuyse, Joseph Giacino, Manfredi Ventura, Melanie Boly, Steve Majerus, Gustave Moonen and Steven Laureys, BMC Neurology 2009, 9:35 doi:10.1186/1471-2377-9-35

Source: BioMed Central

Explore further: US aims for traumatic brain injury clinical trial success

add to favorites email to friend print save as pdf

Related Stories

Will you be misdiagnosed? -- how diagnostic errors happen

Apr 28, 2008

How frequently do doctors misdiagnose patients? While research has demonstrated that the great majority of medical diagnoses are correct, the answer is probably higher than patients expect and certainly higher than doctors ...

The brain predicts our perception of the outside world

Jul 10, 2007

The human brain anticipates our perception of the outside world. For example, it is capable of predicting if we are going to perceive tactile stimulation of weak intensity or, on the contrary, if a more intense ...

Is bipolar disorder overdiagnosed?

May 06, 2008

A new study by Rhode Island Hospital and Brown University researchers reports that fewer than half the patients previously diagnosed with bipolar disorder received a diagnosis of bipolar disorder based on a comprehensive, ...

Misdiagnosis of rheumatoid arthritis

Mar 03, 2008

In an article recommended by Annelies Boonen of Faculty of 1000 Medicine, researchers look at the way rheumatoid arthritis is diagnosed by analysing the administrative databases used by physicians in Quebec.

Recommended for you

Obama's BRAIN initiative gets more than $300 million

1 hour ago

President Barack Obama's initiative to study the brain and improve treatment of conditions like Alzheimer's and autism was given a boost Tuesday with the announcement of more than $300 million in funds.

US aims for traumatic brain injury clinical trial success

13 hours ago

An unprecedented, public-private partnership funded by the Department of Defense (DoD) is being launched to drive the development of better-run clinical trials and may lead to the first successful treatments for traumatic ...

New learning mechanism for individual nerve cells

19 hours ago

The traditional view is that learning is based on the strengthening or weakening of the contacts between the nerve cells in the brain. However, this has been challenged by new research findings from Lund University in Sweden. ...

User comments : 0