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Prognostication and Goals of Care Decisions in Severe Traumatic Brain Injury: A Survey of The Seattle International Severe Traumatic Brain Injury Consensus Conference Working Group
Tuzla Public Hospital, Tuzla, Istanbul, Turkey.
Uniformed Services University of Health Sciences, Avera Brain and Spine Institute, Sioux Falls, South Dakota, USA.
Departments of Neurological Surgery and Orthopaedic Surgery, School of Global Health, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
Almirante Nef Naval Hospital, Viña del Mar, Chile.
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2023 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 40, no 15-16, p. 1707-1717Article in journal (Refereed) Published
Abstract [en]

Best practice guidelines have advanced severe traumatic brain injury (TBI) care; however, there is little that currently informs goals of care decisions and processes despite their importance and frequency. Panelists from the Seattle International severe traumatic Brain Injury Consensus Conference (SIBICC) participated in a survey consisting of 24 questions. Questions queried use of prognostic calculators, variability in and responsibility for goals of care decisions, and acceptability of neurological outcomes, as well as putative means of improving decisions that might limit care. A total of 97.6% of the 42 SIBICC panelists completed the survey. Responses to most questions were highly variable. Overall, panelists reported infrequent use of prognostic calculators, and observed variability in patient prognostication and goals of care decisions. They felt that it would be beneficial for physicians to improve consensus on what constitutes an acceptable neurological outcome as well as what chance of achieving that outcome is acceptable. Panelists felt that the public should help to define what constitutes a good outcome and expressed some support for a "nihilism guard." More than 50% of panelists felt that if it was certain to be permanent, a vegetative state or lower severe disability would justify a withdrawal of care decision, whereas 15% felt that upper severe disability justified such a decision. Whether conceptualizing an ideal or existing prognostic calculator to predict death or an unacceptable outcome, on average a 64-69% chance of a poor outcome was felt to justify treatment withdrawal. These results demonstrate important variability in goals of care decision making and a desire to reduce this variability. Our panel of recognized TBI experts opined on the neurological outcomes and chances of those outcomes that might prompt consideration of care withdrawal; however, imprecision of prognostication and existing prognostication tools is a significant impediment to standardizing the approach to care-limiting decisions.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2023. Vol. 40, no 15-16, p. 1707-1717
Keywords [en]
SIBICC, brain injury, nihilism, prognosis, survey, withdrawal of care
National Category
Neurology
Identifiers
URN: urn:nbn:se:oru:diva-105896DOI: 10.1089/neu.2022.0414ISI: 000978358600001PubMedID: 36932737Scopus ID: 2-s2.0-85159209478OAI: oai:DiVA.org:oru-105896DiVA, id: diva2:1755790
Note

Funding agencies:

National Institute for Health Research (NIHR)  

Adler/Geirsch Attorney at Law 

American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma and Critical Care, Bard Brain

Trauma Foundation 

DePuy 

Hemedex 

Integra 

Neurointensive Care Section of the European Society of Intensive Care Medicine 

Neurosurgical Society of Australasia 

Medtronic 

Moberg Research 

National University of Singapore  

Neuroptics 

Raumedic 

Sophysa 

Stryker 

Zoll 

Available from: 2023-05-09 Created: 2023-05-09 Last updated: 2024-09-04Bibliographically approved

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