Hemphill J Claude, White Douglas B
Department of Neurology, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA.
Emerg Med Clin North Am. 2009 Feb;27(1):27-37, vii-viii. doi: 10.1016/j.emc.2008.08.009.
Mortality and morbidity remain high from neurologic emergencies, such as acute stroke, traumatic brain injury, and hypoxic-ischemic encephalopathy after cardiac arrest. Decisions regarding initial aggressiveness of care must be made at the time of presentation, and perceived prognosis is often used as part of this decision-making process. These decisions are predicated on the accuracy of early outcome prediction, however. Decisions to limit treatment early after neuroemergencies must be balanced with avoidance of self-fulfilling prophecies of poor outcome attributable to clinical nihilism. This article examines the role of prognostication early after neuroemergencies, the potential impact of early treatment limitations, and how these may relate to communication with patients and surrogate decision makers in the context of these acute neurologic events.
诸如急性中风、创伤性脑损伤以及心脏骤停后的缺氧缺血性脑病等神经系统急症的死亡率和发病率仍然很高。在就诊时必须就初始治疗的积极程度做出决定，而感知到的预后情况通常被用作这一决策过程的一部分。然而，这些决定是以早期预后预测的准确性为依据的。在神经系统急症发生后早期做出限制治疗的决定时，必须权衡避免因临床虚无主义导致的自我实现的不良预后预言。本文探讨了神经系统急症发生后早期预后评估的作用、早期治疗限制的潜在影响，以及在这些急性神经系统事件的背景下，这些因素与患者及替代决策者沟通之间的关系。
