Risk, diagnostic error, and the clinical science of consciousness

Andrew Peterson, Damian Cruse, Lorina Naci, Charles Weijer, Adrian M Owen

Research output: Contribution to journalReview articlepeer-review

54 Citations (Scopus)
96 Downloads (Pure)


In recent years, a number of new neuroimaging techniques have detected covert awareness in some patients previously thought to be in a vegetative state/unresponsive wakefulness syndrome. This raises worries for patients, families, and physicians, as it indicates that the existing diagnostic error rate in this patient group is higher than assumed. Recent research on a subset of these techniques, called active paradigms, suggests that false positive and false negative findings may result from applying different statistical methods to patient data. Due to the nature of this research, these errors may be unavoidable, and may draw into question the use of active paradigms in the clinical setting. We argue that false positive and false negative findings carry particular moral risks, which may bear on investigators' decisions to use certain methods when independent means for estimating their clinical utility are absent. We review and critically analyze this methodological problem as it relates to both fMRI and EEG active paradigms. We conclude by drawing attention to three common clinical scenarios where the risk of diagnostic error may be most pronounced in this patient group.

Original languageEnglish
Pages (from-to)588-597
Number of pages10
JournalNeuroImage: Clinical
Early online date20 Feb 2015
Publication statusPublished - 2015


  • Consciousness Disorders
  • Diagnostic Errors
  • Electroencephalography
  • False Negative Reactions
  • False Positive Reactions
  • Humans
  • Magnetic Resonance Imaging
  • Risk
  • Vegetative state
  • Minimally conscious state
  • Unresponsive wakefulness syndrome
  • Brain injury
  • Neurology
  • Statistical methods
  • Active paradigm
  • Mental imagery
  • Ethics
  • Neuroethics
  • Disorders of consciousness


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