OBJECTIVES: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. INTERVENTION: None. MEASUREMENTS: The main outcome measure was physicians' perceptions of prognosis and recommendations on the level of care. MAIN RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVES: 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. DESIGN, SETTING, AND PARTICIPANTS: 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. INTERVENTION: None. MEASUREMENTS: The main outcome measure was physicians' perceptions of prognosis and recommendations on the level of care. MAIN RESULTS: 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. CONCLUSIONS: 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.
Authors: Jennifer A Frontera; J Randall Curtis; Judith E Nelson; Margaret Campbell; Michelle Gabriel; Anne C Mosenthal; Colleen Mulkerin; Kathleen A Puntillo; Daniel E Ray; Rick Bassett; Renee D Boss; Dana R Lustbader; Karen J Brasel; Stefanie P Weiss; David E Weissman Journal: Crit Care Med Date: 2015-09 Impact factor: 7.598
Authors: Jonathan Marehbian; Susanne Muehlschlegel; Brian L Edlow; Holly E Hinson; David Y Hwang Journal: Neurocrit Care Date: 2017-12 Impact factor: 3.210
Authors: Eric Mercier; Amélie Boutin; Michèle Shemilt; François Lauzier; Ryan Zarychanski; Dean A Fergusson; Lynne Moore; Lauralyn A McIntyre; Patrick Archambault; France Légaré; François Rousseau; François Lamontagne; Linda Nadeau; Alexis F Turgeon Journal: CMAJ Open Date: 2016-07-22
Authors: Alexis F Turgeon; Kristin Dorrance; Patrick Archambault; François Lauzier; François Lamontagne; Ryan Zarychanski; Robert Fowler; Lynne Moore; Jacques Lacroix; Shane English; Amélie Boutin; John Muscedere; Karen E A Burns; Donald Griesdale; Lauralyn A McIntyre; Damon Scales; Francis Bernard; Janet Yamada; Janet E Squires Journal: CMAJ Date: 2019-06-17 Impact factor: 8.262