Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit.

摘要: Abstract Objective: To identify the number of patients who were misdiagnosed as being in vegetative state and their characteristics. Design: Retrospective study clinical records medical, occupational therapy, psychology departments. Setting: 20 bed unit specialising rehabilitation with profound brain damage, including state. Subjects: 40 admitted between 1992 1995 a referral diagnosis Outcome measures: Patients showed an ability to communicate consistently using eye pointing or touch sensitive single switch buzzer. Results: Of referred state, 17 (43%) considered having been misdiagnosed; seven these had presumed be for longer than one year, three over four years. Most blind severely visually impaired. All remained physically disabled, but nearly all able preference quality life issues–some high level. Conclusions: The needs considerable skill diagnose, requiring assessment period time; cannot made, even by most experienced clinician, from bedside assessment. Accurate is possible requires skills multidisciplinary team management people complex disabilities. Recognition awareness essential if optimal achieved avoid inappropriate approaches courts declaration withdrawal tube feeding. Key messages Many are have severe visual handicap; thus lack blink threat absence tracking not reliable signs diagnosing Any motor activity, no matter how slight, that can used communication profoundly disabled patient should identified at early stage repeated regular intervals Identification presence neurological disabilities expe- rienced long term disability due damage