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March 18, 2006

Misdiagnosing PVS

Topics: Remembering Terri

Remembering Terri: her feeding tube was removed one year ago today.

I heard Shep Smith on Fox News say several times this afternoon that no one has ever emerged from a persistent vegetative state. There's a good reason for that. When someone shows signs of consciousness, it is not assumed that they have emerged from PVS, it is assumed they were originally misdiagnosed.

Consider this study. Forty PVS patients were studied. They were given therapy to promote communication. Seventeen of the patients (43%!) were found to be able to communicate. The conclusions? These patients were all originally misdiagnosed as PVS, and such a diagnosis cannot be easily made and requires a team of specialists.

Perhaps this is an argument of semantics. Were they misdiagnosed or did they emerge from a PVS? It doesn't really matter. What matters is that in this sample 43% of people thought to be in a PVS were able to improve and learn to communicate. Another thing this study revealed is that a disproportionate number of those "misdiagnosed" were those that were visually impaired. The fact that Terri reacts to her mother's face when she gets very close to Terri may indicate that Terri does not see her well at a distance due to her brain damage.

This study is not unusual, either. I have seen estimates that range from 33% to 60% of PVS patients are misdiagnosed. So is Terri one of these "misdiagnosed," patients who could learn to communicate? Unless she is given the benefit of the type of therapy these test patients received we will never know.

From the abstract of this study:

The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made, even by the most experienced clinician, from a bedside assessment. Accurate diagnosis is possible but requires the skills of a multidisciplinary team experienced in the management of people with complex disabilities. Recognition of awareness is essential if an optimal quality of life is to be achieved and to avoid inappropriate approaches to the courts for a declaration for withdrawal of tube feeding.

Credits: Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit, Keith Andrews, director of medical services; Lesley Murphy, senior clinical psychologist; Ros Munday, senior occupational therapist; Clare Littlewood, senior occupational therapist; Royal Hospital for Neurodisability, London

Original Post: click here

Posted by tim at March 18, 2006 5:44 PM


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