NEUROLOGY 1993;43:1465
© 1993 American Academy of Neurology
Accuracy of diagnosis of persistent vegetative state
Nancy L. Childs, MD,
Walt N. Mercer, MRE and
Helen W. Childs, MS
Healthcare Rehabilitation Center (Dr Childs), Austin, TX, and the Department of Psychology (W.N. Mercer and H.W. Childs), University of North Texas, Denton, TX.
We reviewed pre-admission diagnosis in all patients referred for inpatient brain injury neurorehabilitation over a 5-year period (n = 193). All patients more than 1 month postinjury with diagnosis of coma or persistent vegetative state were selected for review (n = 49). We found that 18 (37%) of these patients were diagnosed inaccurately. Inaccurate diagnosis was more likely if the injury was more than 3 months before admission and the etiology of injury was trauma (48%). Results were statistically significant when traumatic injuries were compared with anoxic injuries (p < 0.10). Errors in diagnosis may result from confusion in terminology, lack of extended observation of patients, and lack of skill or training in the assessment of neurologically devastated patients.
Address correspondence and reprint requests to Dr. Nancy L. Childs, Healthcare Rehabilitation Center, 1106 West Dittmar, Austin, TX 78745.
Received August 13, 1992. Accepted for publication in final form December 24, 1992.
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|
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|
|
|
|
|
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|
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|
|
|
|
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|
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80(8):
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|
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|
|
|
|
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|
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|
|
|
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|
|
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|
|
|
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|
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|
|
|
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|
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|
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|
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|
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|
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|
|
|
|
|
|
|
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|
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|
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