Neuroprognostication

Victoria Fleming; Susanne Muehlschlegel

doi:10.1016/j.ccc.2022.06.005

Neuroprognostication

Crit Care Clin. 2023 Jan;39(1):139-152. doi: 10.1016/j.ccc.2022.06.005. Epub 2022 Oct 13.

Authors

Victoria Fleming¹, Susanne Muehlschlegel²

Affiliations

¹ Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Avenue North, S-5, Worcester, MA 01655, USA.
² Department of Neurology, University of Massachusetts Chan Medical School, 55 Lake Avenue North, S-5, Worcester, MA 01655, USA; Department of Anesthesiology/Critical Care, University of Massachusetts Chan Medical School, 55 Lake Avenue North, S-5, Worcester, MA 01655, USA; Department of Surgery, University of Massachusetts Chan Medical School, 55 Lake Avenue North, S-5, Worcester, MA 01655, USA. Electronic address: susanne.muehlschlegel@umassmed.edu.

PMID: 36333028
DOI: 10.1016/j.ccc.2022.06.005

Abstract

Patients with severe acute brain injury are left incapacitated, critically ill, and unable to make their own medical decisions. Surrogate decision-makers must make life-or-death decisions for patients and rely on clinicians' prognostication for guidance. No guidelines currently exist to guide clinicians in how to prognosticate; hence, neuroprognostication is still considered an "art" leaving room for high variability. This review examines the current literature on prognostication in neurocritical care, identifies ongoing challenges that exist in the field, and provides suggestions for future research with the goal to ameliorate variability and focus on scientific and patient-centered, rather than artistic approaches to prognostication.

Keywords: Neurocritical care; Prognosis; Prognostication; Shared decision-making; Surrogate decision-makers; Uncertainty.

Publication types

Review

MeSH terms

Critical Illness* / therapy
Decision Making*
Humans