Lotteries, loopholes and luck: misdiagnosis in the vegetative state patient.

Many factors contribute to the alarmingly high rates of misdiagnosis in the Vegetative State (VS) patient. These include the differential diagnosis and definitions, inconsistencies in the assessors' knowledge, expertise and their approaches to the assessment of awareness. Variability in the patient's medical and physical management adds to this confusion, leading to the potential to misdiagnose an aware patient in Minimally Conscious State (MCS) as being in VS. Subsequently, this range of variables leads to inconsistencies in the assessment, clinical diagnosis and management of this patient group. This concept is clearly of great importance in terms of the patient's future management and life or death decisions when considering withdrawal of nutrition and hydration. Further exploration of the frequency and causes of misdiagnosis and a review of current guidelines will illustrate the potential loopholes in diagnosis and reveal possible solutions to this modern-day dilemma.