Determination of Neurologic Prognosis and Clinical Decision Making in Adult Patients With Severe Traumatic Brain Injury: A Survey of Canadian Intensivists, Neurosurgeons, and Neurologists
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 seve...
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| Veröffentlicht in: | Critical care medicine 2013-04, Vol.41 (4), p.1086-1093 |
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| creator | Turgeon, Alexis F Lauzier, François Burns, Karen E.A Meade, Maureen O Scales, Damon C Zarychanski, Ryan Moore, Lynne Zygun, David A McIntyre, Lauralyn A Kanji, Salmaan Hébert, Paul C Murat, Valérie Pagliarello, Giuseppe Fergusson, Dean A |
| description | 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 ( |
| doi_str_mv | 10.1097/CCM.0b013e318275d046 |
| format | Article |
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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.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0b013e318275d046</identifier><identifier>PMID: 23385104</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Adult ; Adult and adolescent clinical studies ; Attitude of Health Personnel ; Biological and medical sciences ; Brain Injuries - mortality ; Brain Injuries - therapy ; Critical Care ; Critical Illness - mortality ; Critical Illness - therapy ; Cross-Sectional Studies ; Female ; Humans ; Injuries of the nervous system and the skull. Diseases due to physical agents ; Intensive Care Units - statistics & numerical data ; Length of Stay ; Male ; Medical sciences ; Middle Aged ; Neurology - statistics & numerical data ; Neurosurgery - statistics & numerical data ; Organic mental disorders. Neuropsychology ; Physician's Role ; Physicians - statistics & numerical data ; Practice Patterns, Physicians' - statistics & numerical data ; Prognosis ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Quebec - epidemiology ; Traumas. Diseases due to physical agents</subject><ispartof>Critical care medicine, 2013-04, Vol.41 (4), p.1086-1093</ispartof><rights>2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3356-cb36edf7cabd86dbb4da0c1676c094800d4124b04b9a67e5f98d10085ed037b93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27179457$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23385104$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Turgeon, Alexis F</creatorcontrib><creatorcontrib>Lauzier, François</creatorcontrib><creatorcontrib>Burns, Karen E.A</creatorcontrib><creatorcontrib>Meade, Maureen O</creatorcontrib><creatorcontrib>Scales, Damon C</creatorcontrib><creatorcontrib>Zarychanski, Ryan</creatorcontrib><creatorcontrib>Moore, Lynne</creatorcontrib><creatorcontrib>Zygun, David A</creatorcontrib><creatorcontrib>McIntyre, Lauralyn A</creatorcontrib><creatorcontrib>Kanji, Salmaan</creatorcontrib><creatorcontrib>Hébert, Paul C</creatorcontrib><creatorcontrib>Murat, Valérie</creatorcontrib><creatorcontrib>Pagliarello, Giuseppe</creatorcontrib><creatorcontrib>Fergusson, Dean A</creatorcontrib><creatorcontrib>Canadian Critical Care Trials Group</creatorcontrib><title>Determination of Neurologic Prognosis and Clinical Decision Making in Adult Patients With Severe Traumatic Brain Injury: A Survey of Canadian Intensivists, Neurosurgeons, and Neurologists</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>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.</description><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Attitude of Health Personnel</subject><subject>Biological and medical sciences</subject><subject>Brain Injuries - mortality</subject><subject>Brain Injuries - therapy</subject><subject>Critical Care</subject><subject>Critical Illness - mortality</subject><subject>Critical Illness - therapy</subject><subject>Cross-Sectional Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Injuries of the nervous system and the skull. Diseases due to physical agents</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurology - statistics & numerical data</subject><subject>Neurosurgery - statistics & numerical data</subject><subject>Organic mental disorders. Neuropsychology</subject><subject>Physician's Role</subject><subject>Physicians - statistics & numerical data</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>Prognosis</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Quebec - epidemiology</subject><subject>Traumas. Diseases due to physical agents</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFu1DAQhi0EotuFN0DIFyQOpIzXTpxwW9IClVqo1CKOkWNPdt1m7WInW-2z8XI42qVIHDiNRvPNzC99hLxicMKgku_r-vIEWmAcOSsXMjcgiidkxnIOGSwq_pTMACrIuKj4ETmO8RaAiVzy5-RowXmZMxAz8usUBwwb69RgvaO-o19xDL73K6vpVfAr56ONVDlD6946q1VPT1HbONGX6s66FbWOLs3YD_QqHUE3RPrDDmt6jVsMSG-CGjdpoOnHoBJ67m7HsPtAl_R6DFvcTT9r5ZSxahoO6KLd2jjEd_socQwr9C61U4jHdAl4QZ51qo_48lDn5Puns5v6S3bx7fN5vbzINOd5kemWF2g6qVVrysK0rTAKNCtkoaESJYARbCFaEG2lCol5V5WGAZQ5GuCyrficvN3fvQ_-54hxaDY2aux75dCPsWFclKKSwPOEij2qU_AYsGvug92osGsYNJO2Jmlr_tWW1l4fPoztBs3j0h9PCXhzAFRMCrqgXHLwl5NMVpPbOSn33IPvk9d4148PGJo1qn5Y_z_Db4hDtkg</recordid><startdate>201304</startdate><enddate>201304</enddate><creator>Turgeon, Alexis F</creator><creator>Lauzier, François</creator><creator>Burns, Karen E.A</creator><creator>Meade, Maureen O</creator><creator>Scales, Damon C</creator><creator>Zarychanski, Ryan</creator><creator>Moore, Lynne</creator><creator>Zygun, David A</creator><creator>McIntyre, Lauralyn A</creator><creator>Kanji, Salmaan</creator><creator>Hébert, Paul C</creator><creator>Murat, Valérie</creator><creator>Pagliarello, Giuseppe</creator><creator>Fergusson, Dean A</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201304</creationdate><title>Determination of Neurologic Prognosis and Clinical Decision Making in Adult Patients With Severe Traumatic Brain Injury: A Survey of Canadian Intensivists, Neurosurgeons, and Neurologists</title><author>Turgeon, Alexis F ; Lauzier, François ; Burns, Karen E.A ; Meade, Maureen O ; Scales, Damon C ; Zarychanski, Ryan ; Moore, Lynne ; Zygun, David A ; McIntyre, Lauralyn A ; Kanji, Salmaan ; Hébert, Paul C ; Murat, Valérie ; Pagliarello, Giuseppe ; Fergusson, Dean A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3356-cb36edf7cabd86dbb4da0c1676c094800d4124b04b9a67e5f98d10085ed037b93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Attitude of Health Personnel</topic><topic>Biological and medical sciences</topic><topic>Brain Injuries - mortality</topic><topic>Brain Injuries - therapy</topic><topic>Critical Care</topic><topic>Critical Illness - mortality</topic><topic>Critical Illness - therapy</topic><topic>Cross-Sectional Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Injuries of the nervous system and the skull. Diseases due to physical agents</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurology - statistics & numerical data</topic><topic>Neurosurgery - statistics & numerical data</topic><topic>Organic mental disorders. Neuropsychology</topic><topic>Physician's Role</topic><topic>Physicians - statistics & numerical data</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>Prognosis</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Quebec - epidemiology</topic><topic>Traumas. Diseases due to physical agents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Turgeon, Alexis F</creatorcontrib><creatorcontrib>Lauzier, François</creatorcontrib><creatorcontrib>Burns, Karen E.A</creatorcontrib><creatorcontrib>Meade, Maureen O</creatorcontrib><creatorcontrib>Scales, Damon C</creatorcontrib><creatorcontrib>Zarychanski, Ryan</creatorcontrib><creatorcontrib>Moore, Lynne</creatorcontrib><creatorcontrib>Zygun, David A</creatorcontrib><creatorcontrib>McIntyre, Lauralyn A</creatorcontrib><creatorcontrib>Kanji, Salmaan</creatorcontrib><creatorcontrib>Hébert, Paul C</creatorcontrib><creatorcontrib>Murat, Valérie</creatorcontrib><creatorcontrib>Pagliarello, Giuseppe</creatorcontrib><creatorcontrib>Fergusson, Dean A</creatorcontrib><creatorcontrib>Canadian Critical Care Trials Group</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Turgeon, Alexis F</au><au>Lauzier, François</au><au>Burns, Karen E.A</au><au>Meade, Maureen O</au><au>Scales, Damon C</au><au>Zarychanski, Ryan</au><au>Moore, Lynne</au><au>Zygun, David A</au><au>McIntyre, Lauralyn A</au><au>Kanji, Salmaan</au><au>Hébert, Paul C</au><au>Murat, Valérie</au><au>Pagliarello, Giuseppe</au><au>Fergusson, Dean A</au><aucorp>Canadian Critical Care Trials Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Determination of Neurologic Prognosis and Clinical Decision Making in Adult Patients With Severe Traumatic Brain Injury: A Survey of Canadian Intensivists, Neurosurgeons, and Neurologists</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2013-04</date><risdate>2013</risdate><volume>41</volume><issue>4</issue><spage>1086</spage><epage>1093</epage><pages>1086-1093</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>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.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>23385104</pmid><doi>10.1097/CCM.0b013e318275d046</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Critical care medicine, 2013-04, Vol.41 (4), p.1086-1093 |
| issn | 0090-3493 1530-0293 |
| language | eng |
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| subjects | Adult Adult and adolescent clinical studies Attitude of Health Personnel Biological and medical sciences Brain Injuries - mortality Brain Injuries - therapy Critical Care Critical Illness - mortality Critical Illness - therapy Cross-Sectional Studies Female Humans Injuries of the nervous system and the skull. Diseases due to physical agents Intensive Care Units - statistics & numerical data Length of Stay Male Medical sciences Middle Aged Neurology - statistics & numerical data Neurosurgery - statistics & numerical data Organic mental disorders. Neuropsychology Physician's Role Physicians - statistics & numerical data Practice Patterns, Physicians' - statistics & numerical data Prognosis Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Quebec - epidemiology Traumas. Diseases due to physical agents |
| title | Determination of Neurologic Prognosis and Clinical Decision Making in Adult Patients With Severe Traumatic Brain Injury: A Survey of Canadian Intensivists, Neurosurgeons, and Neurologists |
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