For professionals

Abstract

Objectives
To determine the prevalence of vegetative state in Dutch nursing homes, describe patient characteristics, and highlight the potential influence of end-of-life medical decisions.

Design
A cross-sectional survey. Vegetative state was defined according to the Multi Society Task Force on PVS. All Dutch nursing homes have been approached to provide data on patients in a vegetative state. In case of doubt, the investigator discussed the diagnosis with the patient's doctor and examined the patient if necessary. Information was also recorded on patients in the vegetative state who were in care between 2000 and September 2003 and end-of-life decisions for them.

Results
All nursing homes and doctors participated. After assessing 12 questionable patients, 32 met the criteria of vegetative state lasting more than one month, a prevalence of 2/1 000 000. Of these, the data of 30 patients were analyzed: age 9-90 years; 73% female; Duration of vegetative state 2 months-20 years (26 survivors 1 year, 13.5 years). Stroke was the most common cause. Between 2000 and September 2003, 76 patients were treated in a vegetative state, of whom 34 died from complications and nine after discontinuation of artificial feeding and hydration.

Conclusions
The prevalence of vegetative state in Dutch nursing homes has been established for the first time. The figures are lower than suggested in the literature. The study included a heterogeneous group of patients, a significant number of whom survived for many years. The results cannot be explained by a policy of systematic discontinuation of artificial nutrition and hydration.