Related Experiment Videos
The persistent vegetative state in children: report of the Child Neurology Society Ethics Committee
S Ashwal1, J F Bale, D L Coulter
1Department of Pediatrics, Loma Linda University School of Medicine, CA 92350.
Insights
Pediatricians recognize persistent vegetative state (PVS) in children, with diagnosis timing influenced by age and requiring 3-6 months observation. Management involves continued nutrition and pain medication.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Clinical Diagnosis
Background:
- Persistent vegetative state (PVS) in children raises diagnostic and management concerns.
- A survey of the Child Neurology Society was conducted to address these issues.
Purpose of the Study:
- To survey pediatric neurologists on diagnosing and managing PVS in children.
- To understand expert opinions on PVS diagnostic criteria, observation periods, and life expectancy.
Main Methods:
- A survey was distributed to members of the Child Neurology Society.
- Response rate was 26%.
Main Results:
- 93% of respondents believed PVS diagnosis is possible in children, with age-dependent criteria (infants <2 months: 16%, 2 months-2 years: 70%).
- A 3-6 month observation period was favored, with 86% acknowledging age impacts diagnosis duration. 78% believed diagnosis is possible with severe congenital brain malformations.
- Life expectancy varied by age group, and 75% never withhold nutrition/fluids, while 28% always administer pain medication.
Conclusions:
- Pediatric neurologists generally agree on the possibility of diagnosing PVS in children, but with age-specific considerations.
- Neurodiagnostic studies are considered supportive, and management typically involves continued hydration, nutrition, and pain management.
Abstract:
Increasing concern about children in a persistent vegetative state (PVS) prompted a survey of members of the Child Neurology Society regarding aspects of the diagnosis and management of this disorder. Major findings of those responding to this survey (26% response rate) were as follows: (1) 93% believed that a diagnosis of PVS can be made in children, but only 16% believed that this applied to infants younger than 2 months and 70% in the 2-month to 2-year group; (2) a period of 3 to 6 months was believed to be the minimum observation period required before a diagnosis of PVS could be made; (3) 86% believed that the age of the patient would affect the duration of time needed to make the diagnosis of PVS; (4) 78% thought a diagnosis of PVS could be made in children with severe congenital brain malformations; (5) 75% believed that neurodiagnostic studies would be of value and supportive of the clinical diagnosis of PVS; (6) members' opinions as to the average life expectancy (in years) for the following age groups after the patients were considered vegetative were: newborn to 2 months, 4.1; 2 months to 2 years, 5.5; 2 to 7 years, 7.3; and more than 7 years, 7.4; (7) 20% believed that infants and children in a PVS experience pain and suffering; and (8) 75% "never" withhold fluid and nutrition from infants and children in a PVS and 28% "always" give medication for pain and suffering.(ABSTRACT TRUNCATED AT 250 WORDS)