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Misdiagnosis Plagues Brain Injury Patients

A new study may have serious repercussions for families who have loved ones with serious brain injuries. Researchers at the University of Liege in Belgium have conducted a study which shows that 41% of people who where diagnosed as being in a vegetative state were in fact in a minimally conscious state. This misdiagnosis is a serious problem, since families make decisions based on continuing or discontinuing care for a loved one based on such subtle diagnostic differences.

In 2005, Terri Schindler Schiavo may have been misdiagnosed as in a vegetative state when she may actually have been in a minimally conscious state. If the diagnosis had been made differently, Schiavo may not have died in 2005. A legal battle between Schiavo’s husband and family led to her eventually dying due to starvation and dehydration. At question was whether she was in a minimally conscious state or not. She was officially diagnosed as being in a vegetative state but multiple doctors believed she was in a minimally conscious state.

In the University of Liege in Belgium study, 44 patients who had been diagnosed as being in a vegetative state using the JFK Coma Recovery Scale-Revised were re-tested using medical staff observation. 18 of the patients were found in this manner to be in a minimally conscious state. A person in the vegetative state has no awareness of their surroundings but can breathe on their own and shows normal reflexes. A person in a minimally conscious state can experience emotion and pain and may be able to communicate in small ways.

The chances of recovery are much higher for patients in minimally conscious states, which is one reason why end-of-life decisions tend to be different between the two groups. Misdiagnosis of the two states can lead some families to conclude that there is little chance of recovery when in fact the patient has a much better chance of recovery than suspected.

The study has raised questions about the treatment patients with severe brain injuries receive. The study points to the fact that a number of patients may have their lives terminated even though they show some signs of awareness. Part of the problem, according to researchers, is that a minimally conscious state can be intermittent. That is, patients may show signs of awareness from time to time but not always. A medical professional would need to be watching for these signs over a period of time to determine whether the patient is truly in a minimally conscious state or a vegetative state. The JFK Coma Recovery Scale-Revised, however, does not suggest checking for awareness over the long term.

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