Use of prognostication and withdrawal of care decisions in severe traumatic brain injury

More than 40 traumatic brain injury experts were surveyed on the use of prognostication and withdrawal of care decisions in severe traumatic brain injury (TBI). The survey results are published in the peer-reviewed Journal of Neurotrauma.

Gregory Hawryluk, MD, PhD, Akron General Hospital, and coauthors surveyed panelists from the Seattle International severe traumatic Brain Injury Consensus Conference (SIBICC), querying them on the use of prognostic calculators, variability in and responsibility for goals of care decisions, acceptability of neurological outcomes, and putative means of improving decisions that may limit care.

The responses to most questions were highly variable. Most panelists reported infrequent use of prognostic calculators. Overall, panelists felt that it would be beneficial for physicians to improve consensus on what constitutes an acceptable neurological outcome and what chance of achieving that outcome is acceptable. "Over 50% of panelists felt that if it was certain to be enduring, a vegetative state or lower severe disability would justify a withdrawal of care decision," stated the authors.

"The SIBICC algorithms broke ground by addressing insufficiently informed aspects of TBI care such as when and how to de-escalate therapy," concluded the authors.

This is a tremendously important topic, with profound consequences for our most seriously injured patients. Researchers and clinicians and who care for patients with severe TBI should read this paper carefully."

David L. Brody, MD, PhD, Editor-in-Chief of Journal of Neurotrauma