Clear Terminology Is Required

Letter to the Editor Acute Onset of Impaired Consciousness Diagnostic Evaluation in the Emergency Department by Dr. med. Tobias Weiglein, PD Dr. med. Markus Zimmermann, PD Dr. med. Wolf-Dirk Niesen, Prof. Dr. med. Florian Hoffmann, and Prof. Dr. med. Matthias Klein in issue 15/2024

The authors of this review article surely dealt with an important topic that everyone working in an emergency department will encounter on a daily basis. But I would have wanted for the authors to take this opportunity to use clear and unequivocal language, as they were discussing qualitative and quantitative impaired consciousness. Why, I ask myself, does the German title read “akute Vigilanzminderung” [acute impairment of vigilance] rather than “acute impairment of consciousness” (as in the English translation), especially as the explanation in the article attempts to clarify the terminology (1)?

Studying the occasional scientific paper or paying attention to a conference lecture sometimes triggers impaired vigilance (alertness) in me; in the worst case scenario I fall asleep. This example of an acute change in vigilance is an involuntary but physiological process, which has absolutely nothing to do with “acutely impaired consciousness.” In the cited and general international literature on this subject, the term commonly used is “consciousness” or, for example, “coma.” The authors themselves offered “impaired consciousness“ in the title of their translated article.

On reading the article more closely, sentences such as “Bei [...] Patienten mit schwerer Vigilanzminderung liegen mehrere Pathologien simultan vor“ (“ […] patients with severely impaired consciousness have more than one underlying cause”) is reminiscent of the jargon used in German clinical practice. This could have been improved, also in view of the precision of the language. The reference cited at the end of that sentence (Schmidt et al., 2019) is entitled “Causes of brain dysfunction in acute coma: a cohort study [...]”—the term „impaired vigilance“ was not used.

Overall I make a plea for clear terminology, which also applies to routine clinical practice. For me, impaired consciousness remains impaired consciousness.

DOI: 10.3238/arztebl.m2024.0204

Prof. Dr. med Andreas Moser

Klinik für Neurologie

Universitätsklinikum Schleswig-Holstein

Campus Lübeck

References

1. Weiglein T, Zimmermann M, Niesen WD, Hoffmann F, Klein M: Acute onset of impaired consciousness: diagnostic evaluation in the emergency department. Dtsch Arztebl Int 2024; 121: 508–18