Vegetative state is an extremely rare physical condition of patients with the severe brain damage. The patient is in wakeful but unconscious state and responds to stimulation only in a reflex way. Patient does not respond to the environment on a meaningful way. Patient is awake but completely unaware of the surrounding. A state like this that lasts longer than a few weeks is diagnosed as a persistent vegetative state. Neurodiagnostic tests are unable to confirm such a diagnosis or predict the probability for recovery. Diagnosis requires regular review and taking into account observations made by family and other persons that care about the patient. However, these also may lead to misdiagnosis.
A challenging study was carried out recently. The goal was to identify the number of patients being misdiagnosed of vegetative state. Subjects of the study were forty patients admitted between 1992 and 1995 with a referral diagnosis “vegetative state”. Scientists were trying to find out if any of these patients could communicate consistently using eye pointing or a touch sensitive buzzer. The buzzer switch is particularly appropriate for those patients who are able to generate only a very small amount of movement, which might otherwise go unobserved. Patients who were able to communicate in such a way were to be acclaimed as misdiagnosed.
Results of the research came up as a surprise. As far as 17 patients, or 43% of subjects, were able to communicate consistently. They were terribly misdiagnosed as being in the vegetative state. Most of the patients were blind or seriously physically disabled but many of them had the ability to communicate, some of them even to a high level.
What came as a conclusion is that diagnosis such as “vegetative state” must not be made from a bedside assessment. Accurate diagnosis requires the multidisciplinary approach conducted by special team of experts skilled in the management of people with serious disabilities. Rising awareness
It is very important to make a proper diagnosis for patients suspected of vegetative state. Risks of misdiagnosis are severe and numerous, ranging from the inadequate level of care to possibility to apply to the courts for a directive on withdrawal of tube feeding, hydration or medical help. These findings are not an argument against the withdrawal of artificial nutrition and hydration but do call attention to the significance of precise diagnosis of the vegetative state being made after expert evaluation by an extremely experienced team of medical doctors.