Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists.

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Serval ID
serval:BIB_A63C627DBED7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists.
Journal
Journal of Neurology
Author(s)
Kuehlmeyer K., Racine E., Palmour N., Hoster E., Borasio G.D., Jox R.J.
ISSN
1432-1459 (Electronic)
ISSN-L
0340-5354
Publication state
Published
Issued date
2012
Peer-reviewed
Oui
Volume
259
Number
10
Pages
2076-2089
Language
english
Notes
Publication types: Journal Article
Abstract
Diagnosis and decisions on life-sustaining treatment (LST) in disorders of consciousness, such as the vegetative state (VS) and the minimally conscious state (MCS), are challenging for neurologists. The locked-in syndrome (LiS) is sometimes confounded with these disorders by less experienced physicians. We aimed to investigate (1) the application of diagnostic knowledge, (2) attitudes concerning limitations of LST, and (3) further challenging aspects in the care of patients. A vignette-based online survey with a randomized presentation of a VS, MCS, or LiS case scenario was conducted among members of the German Society for Neurology. A sample of 503 neurologists participated (response rate 16.4%). An accurate diagnosis was given by 86% of the participants. The LiS case was diagnosed more accurately (94%) than the VS case (79%) and the MCS case (87%, p < 0.001). Limiting LST for the patient was considered by 92, 91, and 84% of the participants who accurately diagnosed the VS, LiS, and MCS case (p = 0.09). Overall, most participants agreed with limiting cardiopulmonary resuscitation; a minority considered limiting artificial nutrition and hydration. Neurologists regarded the estimation of the prognosis and determination of the patients' wishes as most challenging. The majority of German neurologists accurately applied the diagnostic categories VS, MCS, and LiS to case vignettes. Their attitudes were mostly in favor of limiting life-sustaining treatment and slightly differed for MCS as compared to VS and LiS. Attitudes toward LST strongly differed according to circumstances (e.g., patient's will opposed treatment) and treatment measures.
Pubmed
Web of science
Open Access
Yes
Create date
08/11/2012 18:25
Last modification date
20/08/2019 15:11
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