Neurologic Outcome Prediction in the Intensive Care Unit

Abstract

PURPOSE OF REVIEW The burden of severe and disabling neurologic injury on survivors, families, and society can be profound. Neurologic outcome prediction, or neuroprognostication, is a complex undertaking with many important ramifications. It allows patients with good prognoses to be supported aggressively, survive, and recover; conversely, it avoids inappropriate prolonged and costly care in those with devastating injuries. RECENT FINDINGS Striving to maintain a high prediction performance during prognostic assessments encompasses acknowledging the shortcomings of this task and the challenges created by advances in medicine, which constantly shift the natural history of neurologic conditions. Embracing the unknowns of outcome prediction and the boundaries of knowledge surrounding neurologic recovery and plasticity is a necessary step toward refining neuroprognostication practices and improving the accuracy of prognostic impressions. The pillars of modern neuroprognostication include comprehensive characterization of neurologic injury burden (primary and secondary injuries), gauging cerebral resilience and estimated neurologic reserve, and tying it all together with individual values surrounding the acceptable extent of disability and the difficulties of an arduous convalescence journey. SUMMARY Comprehensive multimodal frameworks of neuroprognostication using different prognostic tools to portray the burden of neurologic injury coupled with the characterization of individual values and the degree of cerebral reserve and resilience are the cornerstone of modern outcome prediction.

Beyond the Final Heartbeat: Neurological Perspectives on Normothermic Regional Perfusion for Organ Donation after Circulatory Death

“…Neurologists are regularly part of the care team for patients with acute brain injury, guiding evaluation, management, prognostication, and end‐of‐life care 1,2 . Patients who die as a result of catastrophic acute brain injury, either because they fulfill criteria for brain death (or death by neurologic criteria) or they are declared dead by circulatory criteria following withdrawal of life‐sustaining therapy, have the potential to be organ donors 3–5 .…”

Do Neuroprognostic Studies Account for Self-Fulfilling Prophecy Bias in Their Methodology? The SPIN Protocol for a Systematic Review

“…The ongoing process of predicting the course of recovery and ultimate outcome following severe neurologic injury is ubiquitous in clinical practice, and occurs with large gaps in knowledge such that prognostication may resemble an estimation rather than knowledge-based prediction (1). One such gap in knowledge-widely recognized as a major threat to accurate prognostic impressions-is how to account for the impact of self-fulfilling prophecy bias when interpreting results on the prediction performance of neuroprognostic tools (2)(3)(4)(5)(6). Self-fulfilling prophecy bias is a type of confirmation bias that occurs when the results of outcome prediction methods under investigation for their prediction performance influence the outcomes in a cohort.…”