An apparently high rate of misdiagnosis demands critical review and action

Diagnosing the persistent vegetative state is important and sometimes difficult. Patients who retain some degree of awareness must be recognised if their quality of life is to be maximised and inappropriate withdrawal of tube feeding prevented. On p 13 Keith Andrews and colleagues present a retrospective study of the clinical records of 40 patients admitted over three years to a single unit specialising in the rehabilitation of patients with profound brain damage.1 The authors conclude that 17 of these patients were misdiagnosed. Patients in the persistent vegetative state seem to be awake with their eyes open but show no evidence of awareness, but the 17 misdiagnosed patients were able to communicate consistently using eye pointing or a touch sensitive buzzer. Such an apparently high rate of misdiagnosis raises important concerns about the accuracy of the diagnosis of the vegetative state and related syndromes of severe brain damage.1 It also demands a critical review of the study's methods.

One important question is whether the sample of patients is representative. This …