Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment.
Diagnostic accuracy of the vegetative and minimally conscious state: clinical consensus versus standardized neurobehavioral assessment.
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DOI：
10.1186/1471-2377-9-35
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发表时间：
2009-07-21
期刊：
影响因子：
2.6
通讯作者：
Laureys S
中科院分区：
文献类型：
--
作者：
Schnakers C;Vanhaudenhuyse A;Giacino J;Ventura M;Boly M;Majerus S;Moonen G;Laureys S
先前发表的研究报告称，多达43%的意识障碍患者被错误地诊断为植物人状态（VS）。然而，最近没有研究调查这种严重的临床诊断的准确性。在这项研究中，我们比较了基于共识的VS和MCS诊断与基于公认的标准化神经行为评定量表，JFK昏迷恢复量表-修订版（CRS-R）的诊断。我们前瞻性随访了103例（55±19岁）混合病因的患者，并将医生根据医务人员日常观察提供的临床共识诊断与研究人员进行的CRS-R评估得出的诊断进行了比较。所有患者均被诊断为“VS”、“MCS”或“不确定诊断”。根据医疗团队的临床共识诊断为VS的44例患者中，18例（41%）在CRS-R标准化评估后发现为MCS。根据CRS-R，在41例一致诊断为MCS的患者中，4例（10%）已经从MCS中出现。我们还发现，根据CRS-R结果，大多数临床共识诊断不确定的患者（89%）为MCS。尽管诊断准确性很重要，但在过去的15年中，VS的误诊率并没有实质性的变化。与临床共识诊断相比，标准化神经行为评估是建立意识障碍患者鉴别诊断的更敏感手段。
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). 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.' 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. 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.
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影响因子：
48
作者：
Boly, Melanie;Faymonville, Marie-Elisabeth;Laureys, Steven
通讯作者：
Laureys, Steven
影响因子：
11.2
作者：
Wijdicks, EFM;Bamlet, WR;McClelland, RL
通讯作者：
McClelland, RL
影响因子：
5.7
作者：
Laureys, S;Faymonville, ME;Maquet, P
通讯作者：
Maquet, P
影响因子：
3
作者：
Shiel, A;Horn, SA;McLellan, DL
通讯作者：
McLellan, DL
DOI：
10.1016/j.apmr.2004.02.033
发表时间：
2004-12-01
影响因子：
4.3
作者：
Giacino, JT;Kalmar, K;Whyte, J
通讯作者：
Whyte, J