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Diagnostic and ethical challenges in disorders of consciousness and locked-in syndrome: a survey of German neurologists.
[locked-in syndrome]
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
.
Diseases
Validation
Diseases presenting
"minimally conscious state"
symptom
locked-in syndrome
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