For professionals

Introduction

Nowadays, patients after acute brain injury have a greater chance of surviving a comatose phase than in the past. The majority of them regain consciousness, but there is a category of patients in whom consciousness does not return. In them, the eyes usually open within 2-4 weeks and a sleep-wake rhythm develops; The patient is awake, but not conscious. Characteristic of these patients is that behavioral observations show the absence of a functioning cerebral cortex. On the basis of the first description of this state by Jennett and Plum in 1972, the Health Council proposed the term 'vegetative state' in 1994 and provided medical-ethical and legal frameworks for policy.

Making a good diagnosis is a prerequisite for careful decision-making in these patients. There are indications that this is not always done adequately. Misconceptions about terminology, inexperience of the researcher and insufficient time play a role in this.

This prompted us to develop a diagnostic concept for practice from a multiprofessional perspective, based on current insights: how is the diagnosis of 'vegetative state' made as accurately as possible by whom, at what time, using unambiguous terminology and criteria? To answer these questions, one of the authors (J.C.M.L.) conducted a literature review and discussion points were discussed in an expert meeting (all authors). The participants were invited after consultation with the Dutch Center for Brain Injury and the medical professional associations.