Wade, Derick T., Turner-Stokes, Lynne, Playford, E. Diane, Allanson, Judith and Pickard, John (2022) Prolonged disorders of consciousness : a response to a “critical evaluation of the new UK guidelines”. Clinical Rehabilitation, 36 (9). pp. 1267-1275. doi:10.1177/02692155221099704 ISSN 0269-2155.

Preview

PDF WRAP-Prolonged-disorders-of-consciousness-a-response-to-a-critical-evaluation-of-the-new-UK-guidelines-Playford-22.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial 4.0. Download (669Kb) | Preview

Request Changes to record.

Abstract

Background
In 2020, The London Royal College of Physicians published “Prolonged disorders of consciousness following sudden-onset brain injury: national clinical guidelines”. In 2021, in the journal Brain, Scolding et al. published “a critical evaluation of the new UK guidelines”. This evaluation focussed on one of the 73 recommendations in the National Clinical Guidelines. They also alleged that the guidelines were unethical.

Criticisms
They criticised our recommendation not to use activation protocols using fMRI, electroencephalography, or Positron Emission Tomography. They claim these tests can (a) detect ‘covert consciousness’, (b) add predictive value and (c) should be part of routine clinical care. They also suggest that our guideline was driven by cost considerations, leading to clinicians deciding to withdraw treatment at 72 h.

Evidence
Our detailed review of the evidence confirms the American Academy of Neurology Practise Guideline (2018) and the European Academy of Neurology Guideline (2020), which agree that insufficient evidence supports their approach.

Ethics
The ethical objections are based on unwarranted assumptions. Our guideline does not make any recommendations about management until at least four weeks have passed. We explicitly recommend that expert assessors undertake ongoing surveillance and monitoring; we do not suggest that patients be abandoned. Our recommendation will increase the cost We had ethicists in the working party.

Conclusion
We conclude the “critical evaluation” fails to provide evidence for their criticism and that the ethical objections arise from incorrect assumptions and unsupported interpretations of evidence and our guideline. The 2020 UK national guidelines remain valid.

Item Type:	Journal Article
Subjects:	R Medicine > RB Pathology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Persistent vegetative state, Consciousness disorders, Practice guidelines, Persistent vegetative state -- Patients -- Rehabilitation, Persistent vegetative state -- Treatment, Persistent vegetative state -- Moral and ethical aspects
Journal or Publication Title:	Clinical Rehabilitation
Publisher:	Sage Publications Ltd.
ISSN:	0269-2155
Official Date:	September 2022
Dates:	Date Event September 2022 Published 12 May 2022 Available 25 April 2022 Accepted 7 February 2022 Submitted
Volume:	36
Number:	9
Number of Pages:	9
Page Range:	pp. 1267-1275
DOI:	10.1177/02692155221099704
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	18 July 2022
Date of first compliant Open Access:	20 July 2022

Request changes or add full text files to a record

Repository staff actions (login required)

View Item

Downloads