The importance of instrumental assessment in disorders of consciousness: a comparison between American, European, and UK International recommendations

The use of instrumental tools for improving both the diagnostic accuracy and the prognostic soundness in patients with disorders of consciousness (DOC) plays an important role. However, the most recent international guidelines on DOC published by the American and the European Academies of Neurology and by the UK Royal College of Physicians contain heterogeneous recommendations on the implementation of these techniques in the clinical routine for both diagnosis and prognosis. With the present work, starting from the comparison of the DOC guidelines' recommendations, we look for possible explanations behind such discrepancies considering the adopted methodologies and the reference health systems that could have affected the guidelines' perspectives. We made a provocative argument about the need to find the most appropriate common methodology to retrieve and grade the evidence, increase the meta-analytic studies, and reduce the health policies that influence on the guidelines development that, in turn, should inform the health policies with the strongest scientific evidence.

Automated summary

The use of instrumental tools in diagnosing and predicting outcomes in patients with disorders of consciousness is important. However, there are discrepancies in the international guidelines on their implementation in clinical practice. This study compares the recommendations in the guidelines and explores the reasons behind these discrepancies, considering the methodologies and reference health systems used. The study argues for the need to find a common methodology for evidence retrieval and grading, increase meta-analytic studies, and reduce the influence of health policies on guideline development.