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It is a systematic review of all relevant literature, using references from key papers identified. The data are summarized in tables. Five clinical studies of the rate of misdiagnosis in practice were identified, encompassing 236 patients in the vegetative state of whom 80 (34%) were reclassified as having some awareness, often minimal. The studies often included patients in the recovery phase after acute injury, and were poorly reported. Five systematic reviews of signs and technologically based neurophysiological tests were identified, and they showed that most studies were small, lacked accurate or important details, and were subject to bias. Studies were not replicated. Many signs and tests did not differ between people in the vegetative state and in the minimally conscious state, and those that did were unable to diagnose an individual patient. The few single case reports suggest that failure to ensure an accurate diagnosis of the underlying neurological damage and dysfunction could, rarely, lead to significant misdiagnosis usually in patients who had brain\u2010stem damage with little thalamic or cortical damage. Significant misdiagnosis of awareness, with an apparently \u2018vegetative\u2019 patient having good awareness, is rare. Careful neurological assessment of the cause and routine measurement of awareness using the Coma Recovery Scale \u2212 Revised should further reduce mistakes.<\/jats:p>","DOI":"10.1111\/ene.13572","type":"journal-article","created":{"date-parts":[[2018,1,16]],"date-time":"2018-01-16T21:56:37Z","timestamp":1516139797000},"page":"619-625","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["How often is the diagnosis of the permanent vegetative state incorrect? 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