The persistent vegetative state in children: Report of the child neurology society ethics committee

Abstract

Increasing concern about children in a persistent vegetative state (PVS) prompted a survey of members of the Child Neurology Society regarding aspects of the diagnosis and management of this disorder. Major findings of those responding to this survey (26% response rate) were as follows: (1) 93% believed that a diagnosis of PVS can be made in children, but only 16% believed that this applied to infants younger than 2 months and 70% in the 2-month to 2-year group; (2) a period of 3 to 6 months was believed to be the minimum observation period required before a diagnosis of PVS could be made; (3) 86% believed that the age of the patient would affect the duration of time needed to make the diagnosis of PVS; (4) 78% thought a diagnosis of PVS could be made in children with severe congenital brain malformations; (5) 75% believed that neurodiagnostic studies would be of value and supportive of the clinical diagnosis of PVS; (6) members' opinions as to the average life expectancy (in years) for the following age groups after the patients were considered vegetative were: newborn to 2 months, 4.1; 2 months to 2 years, 5.5; 2 to 7 years, 7.3; and more than 7 years, 7.4; (7) 20% believed that infants and children in a PVS experience pain and suffering; and (8) 75% "never" withhold fluid and nutrition from infants and children in a PVS and 28% "always" give medication for pain and suffering.(ABSTRACT TRUNCATED AT 250 WORDS)

Electroencephalography (EEG) and Unconsciousness

“…Non-traumatic causes in adults include acute hypoxic-ischemic neuronal injury suffered during cardiopulmonary arrest, stroke, and meningoencephalitis (Tresch et al , 1991). For children, causes of VS include trauma, meningitis, asphyxia, congenital malformations, and perinatal injuries (Ashwal et al , 1992).…”

Guidelines for Quality Management of Apallic Syndrome / Vegetative State

“…The main causes for AS full, remission, defect, and end states can be summarized as the following [2,5,9,18,21,22,26,28,29,36,53,59,77,78,80,91,106,120,164,180,181]:…”

“…As a result of modern emergency and intensive care medical treatment and diagnostic neuroimaging, many patients who would have died in the past increasingly survive acute traumatic and nontraumatic brain damage and chronic progressive neurological diseases, however, at the expense of full AS, remission defect or end stage, respectively. For Europe prevalence of AS in hospital cases is reported to be 0.5-2/100.000 population/year, about one quarter to one-third secondary to acute traumatic and roughly 70% following acute nontraumatic brain damage and chronic neurological diseases [2,5,18,26,28,29,37,54,59,60]. Over the past two decades, especially designed institutions for early neurological-neurosurgical rehabilitation (ENNR) of apallic patients after severe brain damage and nursing homes for permanent attention stimulating care of completely disabled patients have been established in Europe, thanks to national medical-social health authorities, public and private care providers, and care givers on a legal provision insurance basis [2,14,15,27,28,[60][61][62][63][64][65].…”

“…Patients with CRS sum score of 10 points over 6 weeks were demonstrated not to recover from functional impairment in the long run [15,115]. Younger AS patients after brain trauma have been shown to have a better outcome than older and non traumatic cases [2,4,15,18,19,26,37,111,153,154]. ERBI was first described by Schö nle [156]).…”

Withdrawing life‐sustaining medical treatment—A physician's personal reflection

“…Regardless of the residents' level of training, their treatment plans were strongly influenced by family wishes to treat or withdraw [Rubenstein et al, 1994]. (A 1991 survey of members of The Child Neurology Society Ethics Committee found that 75% would never recommend withholding AHN from children in PVS [Ashwal et al, 1992]). These surveys suggest that pediatric practitioners are less willing to consider withdrawal of AHN, although it should be noted that both of these studies were done before the work of the MultiSociety Task Force and thus are somewhat dated.…”