Gap Analysis Regarding Prognostication in Neurocritical Care: A Joint Statement from the German Neurocritical Care Society and the Neurocritical Care Society
Katja E. Wartenberg,David Y. Hwang,Karl Georg Haeusler,Susanne Muehlschlegel,Oliver W. Sakowitz,Dominik Madžar,Hajo M. Hamer,Alejandro A. Rabinstein,David M. Greer,J. Claude Hemphill,J. Meixensberger,Panayiotis N. Varelas +11 more
TL;DR: The self-fulfilling prophecy, lack of accounting for medical comorbidities, and absence of integration of in-hospital care parameters were identified as major gaps in most prognostic models.
read more
Abstract: Prognostication is a routine part of the delivery of neurocritical care for most patients with acute neurocritical illnesses. Numerous prognostic models exist for many different conditions. However, there are concerns about significant gaps in knowledge regarding optimal methods of prognostication. As part of the Arbeitstagung NeuroIntensivMedizin meeting in February 2018 in Wurzburg, Germany, a joint session on prognostication was held between the German NeuroIntensive Care Society and the Neurocritical Care Society. The purpose of this session was to provide presentations and open discussion regarding existing prognostic models for eight common neurocritical care conditions (aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, traumatic brain injury, traumatic spinal cord injury, status epilepticus, Guillain–Barre Syndrome, and global cerebral ischemia from cardiac arrest). The goal was to develop a qualitative gap analysis regarding prognostication that could help inform a future framework for clinical studies and guidelines. Prognostic models exist for all of the conditions presented. However, there are significant gaps in prognostication in each condition. Furthermore, several themes emerged that crossed across several or all diseases presented. Specifically, the self-fulfilling prophecy, lack of accounting for medical comorbidities, and absence of integration of in-hospital care parameters were identified as major gaps in most prognostic models. Prognostication in neurocritical care is important, and current prognostic models are limited. This gap analysis provides a summary assessment of issues that could be addressed in future studies and evidence-based guidelines in order to improve the process of prognostication.
read more
Chat with Paper
AI Agents for this Paper
Find similar papers on Google Scholar, PubMed and Arxiv
Write a critical review of this paper
Analyze citations of this paper to find unaddressed research gaps
Citations
Ethics and the 2018 Practice Guideline on Disorders of Consciousness
TL;DR: Clinicians are provided guidance for clinicians when interpreting recommendations and professional societies are called on to develop an ethical framework to complement the guideline as it is implemented in clinical practice.
Guidelines for Neuroprognostication in Critically Ill Adults with Intracerebral Hemorrhage.
D. Y. Hwang,Keri S. Kim,Susanne Muehlschlegel,Katja E. Wartenberg,Venkatakrishna Rajajee,Sheila A. Alexander,Katharina M. Busl,Claire J. Creutzfeldt,Gabriel V. Fontaine,Sara E. Hocker,Dominik Madzar,Dea Mahanes,Shraddha Mainali,Oliver W. Sakowitz,Panayiotis N. Varelas,Christian Weimar,Thomas Westermaier,J. Meixensberger +17 more
TL;DR: These guidelines provide recommendations on the formal reliability of predictors of poor outcome in the context of counseling patients with ICH and surrogates and suggest broad principles of neuroprognostication.
Genetic Variants ε2 and ε4 of <scp>APOE</scp> Predict Mortality and Poor Outcome Independently in Spontaneous Intracerebral Hemorrhage Within the Chinese Han Population
Chuyue Wu,Qinji Zhou,Yü Huang,Fei Yan,Zhenjie Yang,Lei He,Qian Li,Li Li +7 more
TL;DR: APOE ε2 and ε4 variants independently predict mortality, recurrence, and poor prognosis in Chinese Han patients with intracerebral hemorrhage, highlighting the need for further investigation into the impact of APOE genotype on intracerebral hemorrhage prognosis and treatment outcomes.
The intersection of prognostication and code status in patients with severe brain injury.
TL;DR: In this article , a comprehensive search of peer-reviewed journals using a wide range of key terms, including prognostication, critical illness, brain injury, cognitive bias, and code status, was conducted.
IL-33 as a Novel Serum Prognostic Marker of Intracerebral Hemorrhage.
TL;DR: In this paper, the significance of serum IL-33 levels on the prognosis of patients with intracerebral hemorrhage (ICH) has not been well studied, and the purpose of this study is to determine whether there is a relationship between the serum IL33 level and the patient's prognosis upon admission.
References
ASSESSMENT OF COMA AND IMPAIRED CONSCIOUSNESS: A Practical Scale
Graham M. Teasdale,Bryan Jennett +1 more
TL;DR: A clinical scale has been evolved for assessing the depth and duration of impaired consciousness and coma that facilitates consultations between general and special units in cases of recent brain damage, and is useful also in defining the duration of prolonged coma.
13.3K
Aspirin plus Clopidogrel as Secondary Prevention after Stroke or Transient Ischemic Attack: A Systematic Review and Meta-Analysis
Qinghua Zhang,Chao Wang,Maoyong Zheng,Yanxia Li,Jincun Li,Liping Zhang,Xiao Shang,Chuanzhu Yan +7 more
TL;DR: Short-term aspirin in combination with clopidogrel is more effective as secondary prevention of stroke or TIA without increasing the risk of hemorrhagic stroke and major bleeding events and the clinical applicability of the findings of this systematic review needs to be confirmed in future clinical trials.
Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines supersede the prior 2007 guidelines and 2009 updates and support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit.
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
William J. Powers,Alejandro A. Rabinstein,Teri Ackerson,Opeolu Adeoye,Nicholas C. Bambakidis,Kyra J. Becker,José Biller,Michael D. Brown,Bart M. Demaerschalk,Brian L. Hoh,Edward C. Jauch,Chelsea S. Kidwell,Thabele M Leslie-Mazwi,Bruce Ovbiagele,Phillip A. Scott,Kevin N. Sheth,Andrew M. Southerland,Deborah V. Summers,David L. Tirschwell +18 more
TL;DR: These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks.
6.3K
Measurements of acute cerebral infarction: a clinical examination scale.
Thomas Brott,Harold P. Adams,Charles P. Olinger,John R. Marler,William G. Barsan,José Biller,Judith Spilker,R Holleran,Robert Eberle,Vicki S. Hertzberg +9 more
TL;DR: A 15-item neurologic examination stroke scale for use in acute stroke therapy trials was designed and interrater reliability for the scale was found to be high, and test-retest reliability was also high, suggesting acceptable examination and scale validity.
5.5K