K. Andrews et al., MISDIAGNOSIS OF THE VEGETATIVE STATE - RETROSPECTIVE STUDY IN A REHABILITATION UNIT, BMJ. British medical journal, 313(7048), 1996, pp. 13-16
Objective-To identify the number of patients who were misdiagnosed as
being in the vegetative state and their characteristics. Design-Retros
pective study of the clinical records of the medical, occupational the
rapy, and clinical psychology departments. Setting-20 bed unit special
ising in the rehabilitation of patients with profound brain damage, in
cluding the vegetative state. Subjects-40 patients admitted between 19
92 and 1995 with a referral diagnosis of vegetative state. Outcome mea
sures-Patients who showed an ability to communicate consistently using
eye pointing or a touch sensitive single switch buzzer. Results-Of th
e 40 patients referred as being in the vegetative state, 17 (43%) were
considered as having been misdiagnosed; seven of these had been presu
med to be vegetative for longer than one year, including three for ove
r four years. Most of the misdiagnosed patients were blind or severely
visually impaired. All patients remained severely physically disabled
, but nearly all were able to communicate their preference in quality
of life issues-some to a high level. Conclusions-The vegetative state
needs considerable skill to diagnose, requiring assessment over a peri
od of time; diagnosis cannot be made, even by the most experienced cli
nician, from a bedside assessment. Accurate diagnosis is possible but
requires the skills of a multidisciplinary team experienced in the man
agement of people with complex disabilities. Recognition of awareness
is essential if an optimal quality of life is to be achieved and to av
oid inappropriate approaches to the courts for a declaration for withd
rawal of tube feeding.