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

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 physici...

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Autores principales: Kuehlmeyer, Katja, Racine, Eric, Palmour, Nicole, Hoster, Eva, Borasio, Gian Domenico, Jox, Ralf J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer-Verlag 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464386/
https://www.ncbi.nlm.nih.gov/pubmed/22407274
http://dx.doi.org/10.1007/s00415-012-6459-9
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author Kuehlmeyer, Katja
Racine, Eric
Palmour, Nicole
Hoster, Eva
Borasio, Gian Domenico
Jox, Ralf J.
author_facet Kuehlmeyer, Katja
Racine, Eric
Palmour, Nicole
Hoster, Eva
Borasio, Gian Domenico
Jox, Ralf J.
author_sort Kuehlmeyer, Katja
collection PubMed
description 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.
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spelling pubmed-34643862012-10-05 Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists Kuehlmeyer, Katja Racine, Eric Palmour, Nicole Hoster, Eva Borasio, Gian Domenico Jox, Ralf J. J Neurol Original Communication 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. Springer-Verlag 2012-03-10 2012 /pmc/articles/PMC3464386/ /pubmed/22407274 http://dx.doi.org/10.1007/s00415-012-6459-9 Text en © The Author(s) 2012 https://creativecommons.org/licenses/by/4.0/ This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Original Communication
Kuehlmeyer, Katja
Racine, Eric
Palmour, Nicole
Hoster, Eva
Borasio, Gian Domenico
Jox, Ralf J.
Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists
title Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists
title_full Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists
title_fullStr Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists
title_full_unstemmed Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists
title_short Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists
title_sort diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of german neurologists
topic Original Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464386/
https://www.ncbi.nlm.nih.gov/pubmed/22407274
http://dx.doi.org/10.1007/s00415-012-6459-9
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