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Determination of Neurologic Prognosis and Clinical Decision Making in Adult Patients With Severe Traumatic Brain Injury

2013; Lippincott Williams & Wilkins; Volume: 41; Issue: 4 Linguagem: Inglês

10.1097/ccm.0b013e318275d046

1530-0293

Alexis F. Turgeon, François Lauzier, Karen E. A. Burns, Maureen O. Meade, Damon C. Scales, Ryan Zarychanski, Lynne Moore, David A. Zygun, Lauralyn McIntyre, Salmaan Kanji, Paul C. Hébert, V Murat, Giuseppe Pagliarello, Dean Fergusson,

Palliative Care and End-of-Life Issues

Accurate prognostic information in patients with severe traumatic brain injury remains limited, but mortality following the withdrawal of life-sustaining therapies is high and variable across centers. We designed a survey to understand attitudes of physicians caring for patients with severe traumatic brain injury toward the determination of prognosis and clinical decision making on the level of care.We conducted a cross-sectional study of intensivists, neurosurgeons, and neurologists that participate in the care of patients with severe traumatic brain injury at all Canadian level 1 and level 2 trauma centers.None.The main outcome measure was physicians' perceptions of prognosis and recommendations on the level of care.Our response rate was 64% (455/712). Most respondents (65%) reported that an accurate prediction of prognosis would be most helpful during the first 7 days. Most respondents (>80%) identified bedside monitoring, clinical exam, and imaging to be useful for evaluating prognosis, whereas fewer considered electrophysiology tests (<60%) and biomarkers (<15%). In a case-based scenario, approximately one-third of respondents agreed, one-third were neutral, and one-third disagreed that the patient prognosis would be unfavorable at one year. About 10% were comfortable recommending withdrawal of life-sustaining therapies.A significant variation in perceptions of neurologic prognosis and in clinical decision making on the level of care was found among Canadian intensivists, neurosurgeons, and neurologists. Improved understanding of the factors that can accurately predict prognosis for patients with traumatic brain injury is urgently needed.