Electronic annex 2f
Formal evaluation and record of diagnosis of VS or MCS
All aspects need to be completed and signed off by a designated expert physician in prolonged
disorders of consciousness (PDOC).
Patient name:
Registration number (Database):
Date of injury:
Expert physician:
Minimum requirement
Detail
Date of assessment:
1
TIME FRAME
Time since injury:
Has remained continually in DOC for a minimum of 4
weeks post injury
2
SPECIALISED SETTING
Admitted to a designated specialised PDOC unit
or managed in an appropriate setting under the
supervision of outreach team for an appropriate period
of time – minimum 6 weeks but more usually 3–4
months
NB: If not in a designated unit
Managed and assessed in a unit (usually Level 1 or 2
neurorehab setting) with appropriate staffing levels,
expertise in management and formal assessment of
PDOC, and all requirements below have been met
Completed
and signed/
Date
Unit
Unit
3
MEDICAL MANAGEMENT
General medical condition has been stabilised as far as possible, including:
a
Medically stable:
Free from major sepsis and other serious inter-current
illness affecting consciousness
b
Medications have been reviewed to minimise sedation
c
Clinical examination of sensory pathways has been
undertaken
d
Imaging/investigations
As appropriate to eliminate remediable cause of PDOC
(cont’d)
1
Minimum requirement
Detail
4
SPECIALIST MANAGEMENT PROGRAMME
All essential requirements for management are addressed:
a
Tone:
Active spasticity management in place,
including medication
b
Positioning:
A 24-hour programme of positioning is
in place with a range of positions
available including bed and chair
(unless contraindicated)
c
Has appropriate seating system and
sitting tolerance at least 1 hour at a
time – preferably up to several
hours/day
or, if in bed – at least sitting up in
profile in midline for 1 hour
d
Arousal levels recorded:
Measures have been taken to maximise
arousal
e
Optimised environment:
Consideration has been given to
optimising the environment for
interaction (adequate light, avoidance
of distraction/ overstimulation, rest
periods)
f
Facilitated communication:
Has been assessed by clinicians
experienced in PDOC to explore ability
to access switches/use of
communication aids etc
g
Controlled sensory stimulation
programme:
Patient has been exposed to a range of
controlled stimuli
5
FAMILY/IMPORTANT RELATIONSHIPS
Family informed and educated re
sensory stimulation and responses etc,
and involved in the programme (if
able).
2
Completed
and signed/
Date
6
Detail
FORMAL ASSESSMENT
(cont’d)
Checked and
signed/Date
FOR CONTINUING VS OR MCS
Has undergone formal assessment as follows:
Acute setting/ITU :
‒ WHIM (at least 10 occasions)
Rehabilitation/post-acute:
VS or ?MCS minus
No awareness or no consistent responses seen,
ie VS or MCS
 WHIM at least 2–3 per week over 4 weeks
 or full SMART
 other assessments (eg CRS-R) optional
MCS
Clear evidence of awareness and response albeit
inconsistently
 WHIM at least 2–3 per week over 4 weeks
 SMART (optional)
 other assessments (eg CRS-R) optional
Long term:
 WHIM
 SMART – only indicated if:
 significant change identified by
family/team and reviewed by trained
assessor to establish if full re-assessment
is necessary
or
– required to inform key decisions,
eg application for withdrawal of CANH
I hereby confirm that ………………………………………………………………. (Patient name)
has met all of the above criteria for:
☐ Continuing vegetative state
☐ Continuing minimally conscious state (delete as applicable)
Date: ……/……/……. (………………….weeks since brain injury)
Signed: ………………………………………………………….
Print name: …………………………………………………..
(Expert in assessment of prolonged disorders of consciousness)
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Detail
FORMAL ASSESSMENT
Checked and
signed/Date
FOR PERMANENT VS OR MCS
Has undergone formal assessment as follows:
Time frame
Date of review:
VS:
Non traumatic – at 6 months post injury or
Traumatic – at 12 months post injury
MCS:
Non traumatic – at 3 years post injury
Traumatic – at 5 years post injury
Medical management
No evidence of remediable medical condition
contributing to low awareness
Specialist management
Patient has had an adequate period (at least 3
months) of specialist management, meeting the
conditions laid out in section 4 above.
Formal assessment
SMART has been done ……………..
Serial WHIMs over time show no significant change
since the previous assessment
I hereby confirm that ………………………………………………………………. (Patient name)
who was diagnosed as in continuing MCS/VS on ………………………… (Date)
has met all of the above criteria for:
☐ Permanent vegetative state
☐ Permanent minimally conscious state (delete as applicable)
Signed: …………………………………………………………..
Print name: …………………………………………………..
Expert in assessment of prolonged disorders of consciousness
Source: Royal College of Physicians. Prolonged disorders of consciousness: national clinical guidelines. London: RCP,
2013.
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