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The Vegetative State: Prevalence, Misdiagnosis, and Treatment Limitations.
- Source :
-
Journal of the American Medical Directors Association . Jan2015, Vol. 16 Issue 1, p85.e9-85.e14. 1p. - Publication Year :
- 2015
-
Abstract
- Introduction Patients in a vegetative state/unresponsive wakefulness syndrome (VS/UWS) open their eyes spontaneously, but show only reflexive behavior. Although VS/UWS is one of the worst possible outcomes of acquired brain injury, its prevalence is largely unknown. This study's objective was to map the total population of hospitalized and institutionalized patients in VS/UWS in the Netherlands: prevalence, clinical characteristics, and treatment limitations. Methods Nationwide point prevalence study on patients in VS/UWS at least 1 month after acute brain injury in hospitals, rehabilitation centers, nursing homes, institutions for people with intellectual disability, and hospices; diagnosis verification by a researcher using the Coma Recovery Scale-revised (CRS-r); gathering of demographics, clinical characteristics, and treatment limitations. Results We identified 33 patients in VS/UWS, 24 of whose diagnoses could be verified. Patients were on average 51 years old with a mean duration of VS/UWS of 5 years. The main etiology was hypoxia sustained during cardiac arrest and resuscitation. More than 50% of patients had not received rehabilitation services. Most were given life-sustaining treatment beyond internationally accepted prognostic boundaries regarding recovery of consciousness. Seventeen (39%) of 41 patients presumed to be in VS/UWS were found to be at least minimally conscious. Conclusions Results translate to a prevalence of 0.1 to 0.2 hospitalized and institutionalized VS/UWS patients per 100,000 members of the general population. This small figure may be related to the legal option to withhold or withdraw life-sustaining treatment, including artificial nutrition and hydration. On the other hand, this study shows that in certain cases, physicians continue life-prolonging treatment for up to 25 years. Patients have poor access to rehabilitation and are at substantial risk for misdiagnosis. [ABSTRACT FROM AUTHOR]
- Subjects :
- *COMPLICATIONS of brain injuries
*CEREBRAL anoxia
*DIAGNOSTIC errors
*EPIDEMIOLOGICAL research
*HEALTH services accessibility
*HOSPICE care
*HOSPITAL care
*HOSPITALS
*INSTITUTIONAL care
*LIFE support systems in critical care
*LONG-term health care
*NEUROPSYCHOLOGICAL tests
*NURSING care facilities
*REHABILITATION centers
*RESEARCH funding
*CROSS-sectional method
*DISEASE duration
*PERSISTENT vegetative state
*DESCRIPTIVE statistics
*DISEASE complications
*SYMPTOMS
*DIAGNOSIS
*THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 15258610
- Volume :
- 16
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- Journal of the American Medical Directors Association
- Publication Type :
- Academic Journal
- Accession number :
- 100063212
- Full Text :
- https://doi.org/10.1016/j.jamda.2014.10.014