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When to withdraw care in severe traumatic brain injury

When to withdraw care in severe traumatic brain injury
SIBICC panelists' views on acceptable outcomes and chances of those outcomes. For (A), SIBICC panelists selected all Extended Glasgow Outcome Scale (GOS) scores that they felt were sufficiently poor to justify withdrawal of care decisions. For (B), panelists considered predictions computed with ideal or existing prognostic calculators and the lowest chance of death or unacceptable outcome at which they would agree to a withdrawal of care decision. Responses were highly variable and presented via box and whisker plots. Values ranged from 64% to 69% depending on the scenario, and were not statistically different on analysis of variance (ANOVA) testing. SIBICC, Seattle International severe traumatic Brain Injury Consensus Conference; UO, unacceptable outcome. Credit: Journal of Neurotrauma (2023). DOI: 10.1089/neu.2022.0414

Gregory Hawryluk, MD, Ph.D., Akron General Hospital, and co-authors 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 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 ," says David L. Brody, MD, Ph.D., Editor-in-Chief of Journal of Neurotrauma. "Researchers and clinicians and who care for with severe TBI should read this paper carefully."

More information: Buse Sarigul et al, Prognostication and Goals of Care Decisions in Severe Traumatic Brain Injury: A Survey of The Seattle International Severe Traumatic Brain Injury Consensus Conference Working Group, Journal of Neurotrauma (2023). DOI: 10.1089/neu.2022.0414

Journal information: Journal of Neurotrauma
Citation: When to withdraw care in severe traumatic brain injury (2023, May 15) retrieved 2 March 2024 from
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