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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer-Verlag
2012
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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. |
format | Online Article Text |
id | pubmed-3464386 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Springer-Verlag |
record_format | MEDLINE/PubMed |
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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