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