School of Medicine, Trinity College Dublin, Dublin, Ireland.
Ir J Med Sci. 2013 Mar;182(1):7-15. doi: 10.1007/s11845-012-0825-6. Epub 2012 Apr 24.
In the absence of reliable, objective and direct measures of awareness, the diagnosis and prognosis of the vegetative and minimally conscious states are greatly complicated. This has led to an unacceptably high level of misdiagnosis. Although diagnosis and prognosis have typically relied on bedside behavioural measures, a number of recent studies on neuroimaging and neurophysiological methods offer the possibility of improvement in these areas.
We examined current clinical practice and possible future directions in the diagnosis, prognosis and treatment of disorders of consciousness, as well as the ethical and legal dilemmas associated with these disorders. We also summarise epidemiological data from three specialist rehabilitation hospitals in Ireland.
We recommend an international agreement on standard behavioural assessment. This would enable greater consistency in diagnosis and prognostication, as well as improved accuracy of epidemiological data. Based on the current evidence, we advocate the introduction of neuroimaging and neurophysiological techniques into the standardised investigation profile. A more detailed epidemiological study is also required in Ireland.
在缺乏可靠、客观和直接的意识测量方法的情况下，植物状态和最小意识状态的诊断和预后变得非常复杂。这导致了极高的误诊率。尽管诊断和预后通常依赖于床边行为测量，但最近的一些关于神经影像学和神经生理学方法的研究为这些领域的改善提供了可能。
我们检查了意识障碍的诊断、预后和治疗的当前临床实践和可能的未来方向，以及与这些障碍相关的伦理和法律困境。我们还总结了爱尔兰三家专业康复医院的流行病学数据。
我们建议就标准行为评估达成国际协议。这将使诊断和预后更加一致，并提高流行病学数据的准确性。基于现有证据，我们主张将神经影像学和神经生理学技术引入标准化调查方案。爱尔兰也需要进行更详细的流行病学研究。
