International variability in the diagnosis and management of disorders of consciousness

Lewis, Ariane

doi:10.1016/j.lpm.2022.104162

Cited by 5 publications

(2 citation statements)

References 99 publications

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“…A recent meta-analysis demonstrated improved survival and neurologic outcomes in patients with acute brain injury who received subspecialized neurocritical care services, highlighting the importance of neurologic expertise and subspecialty care for patients with acute neurologic emergencies 10 . However, geographic disparities in access to neurocritical care 11 and variations in the initial care and workup of patients with neurologic emergencies have been described 12,13 …”

Section: Introductionmentioning

confidence: 99%

“…J UN E 2 024 However, geographic disparities in access to neurocritical care 11 and variations in the initial care and workup of patients with neurologic emergencies have been described. 12,13 This article provides a structured diagnostic approach to the initial evaluation of patients in neurocritical care settings, including the recognition of critical pathology, relevant clinical examination findings, and the use of diagnostic tests to guide critical and time-sensitive treatment decisions.…”

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confidence: 99%

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The Neurocritical Care Examination and Workup

Wahlster,

Johnson

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article provides an overview of the evaluation of patients in neurocritical care settings and a structured approach to recognizing and localizing acute neurologic emergencies, performing a focused examination, and pursuing workup to identify critical findings requiring urgent management. LATEST DEVELOPMENTS After identifying and stabilizing imminent threats to survival, including respiratory and hemodynamic compromise, the initial differential diagnosis for patients in neurocritical care is built on a focused history and clinical examination, always keeping in mind critical “must-not-miss” pathologies. A key priority is to identify processes warranting time-sensitive therapeutic interventions, including signs of elevated intracranial pressure and herniation, acute neurovascular emergencies, clinical or subclinical seizures, infections of the central nervous system, spinal cord compression, and acute neuromuscular respiratory failure. Prompt neuroimaging to identify structural abnormalities should be obtained, complemented by laboratory findings to assess for underlying systemic causes. The indication for EEG and lumbar puncture should be considered early based on clinical suspicion. ESSENTIAL POINTS In neurocritical care, the initial evaluation is often fast paced, requiring assessment and management to happen in parallel. History, clinical examination, and workup should be obtained while considering therapeutic implications and the need for lifesaving interventions.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

The Neurocritical Care Examination and Workup

Wahlster,

Johnson

2024

CONTINUUM: Lifelong Learning in Neurology

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Equity in Clinical Care and Research Involving Persons with Disorders of Consciousness

Rubin,

Lewis,

Creutzfeldt

et al. 2024

Neurocrit Care

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Shared Decision-Making for Patients with Stroke in Neurocritical Care: A Qualitative Meta-Synthesis

Zhang,

Davies,

Stokes

et al. 2024

Neurocrit Care

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Decision-making for patients with stroke in neurocritical care is uniquely challenging because of the gravity and high preference sensitivity of these decisions. Shared decision-making (SDM) is recommended to align decisions with patient values. However, limited evidence exists on the experiences and perceptions of key stakeholders involved in SDM for neurocritical patients with stroke. This review aims to address this gap by providing a comprehensive analysis of the experiences and perspectives of those involved in SDM for neurocritical stroke care to inform best practices in this context. A qualitative meta-synthesis was conducted following the methodological guidelines of the Joanna Briggs Institute (JBI), using the thematic synthesis approach outlined by Thomas and Harden. Database searches covered PubMed, CIHAHL, EMBASE, PsycINFO, and Web of Science from inception to July 2023, supplemented by manual searches. After screening, quality appraisal was performed using the JBI Appraisal Checklist. Data analysis comprised line-by-line coding, development of descriptive themes, and creation of analytical themes using NVivo 12 software. The initial search yielded 7,492 articles, with 94 undergoing full-text screening. Eighteen articles from five countries, published between 2010 and 2023, were included in the meta-synthesis. These studies focused on the SDM process, covering life-sustaining treatments (LSTs), palliative care, and end-of-life care, with LST decisions being most common. Four analytical themes, encompassing ten descriptive themes, emerged: prognostic uncertainty, multifaceted balancing act, tripartite role dynamics and information exchange, and influences of sociocultural context. These themes form the basis for a conceptual model offering deeper insights into the essential elements, relationships, and behaviors that characterize SDM in neurocritical care. This meta-synthesis of 18 primary studies offers a higher-order interpretation and an emerging conceptual understanding of SDM in neurocritical care, with implications for practice and further research. The complex role dynamics among SDM stakeholders require careful consideration, highlighting the need for stroke-specific communication strategies. Expanding the evidence base across diverse sociocultural settings is critical to enhance the understanding of SDM in neurocritical patients with stroke.Trial registration This study is registered with PROSPERO under the registration number CRD42023461608.

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International variability in the diagnosis and management of disorders of consciousness

Cited by 5 publications

References 99 publications

The Neurocritical Care Examination and Workup

The Neurocritical Care Examination and Workup

Equity in Clinical Care and Research Involving Persons with Disorders of Consciousness

Shared Decision-Making for Patients with Stroke in Neurocritical Care: A Qualitative Meta-Synthesis

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