Clinical Decision Making in Severe Brain Injury

To the Editor.  —The recently published findings of the Traumatic Coma Data Bank¹ (TCDB) have significant implications for clinical decision making in severe brain injury, particularly the observations that 52% of patients who were diagnosed as being in a vegetative state (VS) at approximately 1 month after trauma "recovered consciousness" by 1 year and that there were no good predictors of status at 1 or 3 years among this subset of VS patients. These observations have direct implications for the American Academy of Neurology (AAN) Position Statement on persistent VS.² First, there is a risk of erroneously applying the AAN "1 to 3 months" criterion for diagnosis of persistent VS to traumatically brain-injured patients, simply because no other guidelines are provided in the position statement. How