title: Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Coma Science Group, Cyclotron Research Center, University of Liege, Belgium. c.schnakers@hotmail.com
authors.forename: Caroline
authors.initials: C
authors.lastname: Schnakers
authors.forename: Audrey
authors.initials: A
authors.lastname: Vanhaudenhuyse
authors.forename: Joseph
authors.initials: J
authors.lastname: Giacino
authors.forename: Manfredi
authors.initials: M
authors.lastname: Ventura
authors.forename: Melanie
authors.initials: M
authors.lastname: Boly
authors.forename: Steve
authors.initials: S
authors.lastname: Majerus
authors.forename: Gustave
authors.initials: G
authors.lastname: Moonen
authors.forename: Steven
authors.initials: S
authors.lastname: Laureys
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D018458:Persistent Vegetative State / Q000175:diagnosis*