The minimally conscious state: Definition and diagnostic criteria

Giacino, J.T.; Ashwal, S.; Childs, N.; Cranford, R.; Jennett, B.; Katz, D.I.; Kelly, J.P.; Rosenberg, J.H.; Whyte, J.; Zafonte, R.D.; Zasler, N.D.

doi:10.1212/wnl.58.3.349

Cited by 2,422Traumatic Brain Injury ResearchPhilosophy and Theoretical ScienceIntensive Care Unit Cognitive Disorders

The minimally conscious state: Definition and diagnostic criteria

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Giacino, J.T., Ashwal, S., Childs, N., Cranford, R., Jennett, B., Katz, D.I., Kelly, J.P., Rosenberg, J.H. +3 more·2002·Neurology

DOI 10.1212/wnl.58.3.349

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Abstract

OBJECTIVE: To establish consensus recommendations among health care specialties for defining and establishing diagnostic criteria for the minimally conscious state (MCS). BACKGROUND: There is a subgroup of patients with severe alteration in consciousness who do not meet diagnostic criteria for coma or the vegetative state (VS). These patients demonstrate inconsistent but discernible evidence of consciousness. It is important to distinguish patients in MCS from those in coma and VS because preliminary findings suggest that there are meaningful differences in outcome. METHODS: An evidence-based literature review of disorders of consciousness was completed to define MCS, develop diagnostic criteria for entry into MCS, and identify markers for emergence to higher levels of cognitive function. RESULTS: There were insufficient data to establish evidence-based guidelines for diagnosis, prognosis, and management of MCS. Therefore, a consensus-based case definition with behaviorally referenced diagnostic criteria was formulated to facilitate future empirical investigation. CONCLUSIONS: MCS is characterized by inconsistent but clearly discernible behavioral evidence of consciousness and can be distinguished from coma and VS by documenting the presence of specific behavioral features not found in either of these conditions. Patients may evolve to MCS from coma or VS after acute brain injury. MCS may also result from degenerative or congenital nervous system disorders. This condition is often transient but may also exist as a permanent outcome. Defining MCS should promote further research on its epidemiology, neuropathology, natural history, and management.

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The command-following test is assumed to be a reliable indicator of consciousness in many clinical contexts-an embedded assumption in the diagnostic criteria for the minimally conscious state.
“An example of a C-test with high speci fi city (in humans) is the command-following test [32], which is assumed to be a reliable indicator of consciousness in many clinical contexts -an embedded assumption in the diagnostic criteria for the minimally conscious state [52].”
From Tests for consciousness in humans and beyond (2024) · cites this paper as [52]

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Authors: Giacino, J. T., Ashwal, S., Childs, N., Cranford, R., Jennett, B., Katz, D. I., Kelly, J. P., Rosenberg, J. H., Whyte, J., Zafonte, R. D., & Zasler, N. D.
Affiliations: Loma Linda University Medical Center (US)
ORCID: Giacino, J.T.
Ashwal, S.
Katz, D.I.
Kelly, J.P.
Whyte, J.
Zafonte, R.D.
Zasler, N.D.
Venue: Neurology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2002-02-12
Volume: 58
Issue: 3
Pages: 349-353
ISSN: 0028-3878 (ISSN-L)
1526-632X
DOI: 10.1212/wnl.58.3.349
OpenAlex: W2168575964
Cited by: 2,422
References: 34
Citations by year: 2026: 83 · 2025: 123 · 2024: 150 · 2023: 144 · 2022: 129 · 2021: 132 · 2020: 151 · 2019: 113 · 2018: 137 · 2017: 132 · 2016: 106 · 2015: 119 · 2014: 123 · 2013: 126 · 2012: 117
FWCI: 27.80
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Neurology (publishedVersion)
PubMed (publishedVersion)
DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Funders: JFK Medical Center Foundation
School of Medicine, Boston University
University of Pittsburgh
Hennepin County Medical Center
Loma Linda University
American Academy of Physical Medicine and Rehabilitation
University of Glasgow
Topics: Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Philosophy and Theoretical Science
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
Keywords: minimally conscious state, disorders of consciousness, diagnostic criteria, coma, vegetative state, case definition, prognosis, acute brain injury, degenerative neurological disorders, emergence of consciousness
MeSH terms: Humans, Neurologic Examination, Persistent Vegetative State

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The minimally conscious state: Definition and diagnostic criteria

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