TY - JOUR
T1 - Prolonged disorders of consciousness
T2 - A response to a “critical evaluation of the new UK guidelines.”
AU - Wade, Derick T.
AU - Turner-Stokes, Lynne
AU - Playford, E. Diane
AU - Allanson, Judith
AU - Pickard, John
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2022/9
Y1 - 2022/9
N2 - 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.
AB - 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.
KW - activation protocol
KW - guideline
KW - Prolonged disorders of consciousness
UR - http://www.scopus.com/inward/record.url?scp=85130461569&partnerID=8YFLogxK
U2 - 10.1177/02692155221099704
DO - 10.1177/02692155221099704
M3 - Article
AN - SCOPUS:85130461569
SN - 0269-2155
VL - 36
SP - 1267
EP - 1275
JO - Clinical Rehabilitation
JF - Clinical Rehabilitation
IS - 9
ER -