The vegetative state – clinical diagnosis

Guidelines for Quality Management of Apallic Syndrome / Vegetative State

“…The prevalence of AS in European countries with regard to its etiology and regional distribution, patient's age and sex, concomitant organ failures, and risk factors is not exactly known because of (a) regionally dependent differences in the incidence of traumatic and nontraumatic causes, (b) question of mistaken diagnosis, (c) confusion over correct naming and etiology [2,15,37,59,60,[127][128][129][134][135][136] 854.5: intracranial injury with AS. There were 31 adults and one child.…”

“…However, in the case the AS patient stays longer than 28 days in the early rehabilitation unit, the individually assessed local daily recompensation will be paid for the patient covering all expenses of inhospital treatment from the first day. Using data collected from care givers or insurance companies might be risky and lead to false statistics of AS when diagnosis of the most expensive brain damage is mentioned for medical care money considerations in the managed care system of our days [14,15,[59][60][61]127]. One has to be aware that patients suspected to be AS patients are often wrongly diagnosed by general practitioners and specialists, as it was the case in 43% of patients checked by Andrews et al [60,67,94,128,[134][135][136].…”

“…Regarding the reported high level of AS/VS misdiagnosis [127][128][129] we would like to suggest a practical education in AS management for at least three years like in other sub-specialities. This should qualify the doctor too to furnish the expert opinion concerning the right diagnose of a (permanent) AS full stage and early remission stages [6,14,54,67,69,72,[132][133][134][135].…”

“…This should qualify the doctor too to furnish the expert opinion concerning the right diagnose of a (permanent) AS full stage and early remission stages [6,14,54,67,69,72,[132][133][134][135]. Detailed assessment is important if the reported high level of misdiagnosis is to be avoided [127,[67][68][69]. Evaluation needs a considerable amount of time, measured in weeks rather than hours, and during different day times, if varying levels of function are to be identified and correctly classified on a special questionnaire.…”

“…At present there is no class I evidence management available for AS or VS. From MEDLINE research over the last decade only a few references could be found on AS but some 640 for VS/PVS. Doctors' inexperience and disagreement with regard to the diagnosis of AS is reflected in the literature [26,36,37,106,[121][122][123][124][125][126][127][128][129]. Therefore, we collected reports on best practice and extensively used the task force members' expertise of AS management as each of them has been in charge of and responsible for AS management in all kinds of specialized rehabilitation institutions for at least 10 years.…”