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: Conceptual representation in the brain: Towards mind-reading

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

Turning off depression in the brain

12 hours ago

Scientists have traced vulnerability to depression-like behaviors in mice to out-of-balance electrical activity inside neurons of the brain's reward circuit and experimentally reversed it – but there's ...

Rapid whole-brain imaging with single cell resolution

13 hours ago

A major challenge of systems biology is understanding how phenomena at the cellular scale correlate with activity at the organism level. A concerted effort has been made especially in the brain, as scientists are aiming to ...

User comments : 0

More news stories

Chronic inflammation linked to 'high-grade' prostate cancer

Men who show signs of chronic inflammation in non-cancerous prostate tissue may have nearly twice the risk of actually having prostate cancer than those with no inflammation, according to results of a new study led by researchers ...

Turning off depression in the brain

Scientists have traced vulnerability to depression-like behaviors in mice to out-of-balance electrical activity inside neurons of the brain's reward circuit and experimentally reversed it – but there's ...

Better thermal-imaging lens from waste sulfur

Sulfur left over from refining fossil fuels can be transformed into cheap, lightweight, plastic lenses for infrared devices, including night-vision goggles, a University of Arizona-led international team ...

Hackathon team's GoogolPlex gives Siri extra powers

(Phys.org) —Four freshmen at the University of Pennsylvania have taken Apple's personal assistant Siri to behave as a graduate-level executive assistant which, when asked, is capable of adjusting the temperature ...