Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia, Australia.
J Neurotrauma. 2011 Jan;28(1):13-9. doi: 10.1089/neu.2010.1584.
The use of a prognostic model to aid clinician decision-making with regard to decompressive craniectomy for patients with severe neurotrauma has not been examined. Thus in this study we assessed whether an internationally validated prediction model would influence clinician decision-making about craniectomy. A two-part structured interview, given before and after knowing the predicted risks of unfavorable neurological outcomes at 6 months, was used to assess the participants' recommendations about performing decompressive craniectomy in three patients with severe traumatic brain injury. The participants rated their preferences when there was no surrogate decision maker available, when the next of kin requested surgical intervention, when the patient had an advance directive, and when the participant was the injured party. A visual analogue scale (1-10) was used to assess the strength of their opinions. A total of 50 neurosurgeons and intensive care physicians participated in this study. The participants were significantly more likely to recommend decompressive craniectomy for their patients than for themselves, especially when the next of kin of the patient demanded the procedure, and were more similar in their own preferences to patients who had advance directives. Clinicians' preferences to perform the procedure for both themselves and their patients was significantly reduced after knowing the predicted risks of unfavorable outcomes, and these changes in attitude were consistent across those with different specialties, regardless of the amount of experience caring for similar patients, or religious background. In conclusion, the predicted risks of unfavorable outcomes influenced clinician decision-making about recommending decompressive craniectomy for patients with very severe neurotrauma.
尚未研究使用预后模型来帮助临床医生就严重神经创伤患者的去骨瓣减压术做出决策。因此，在这项研究中，我们评估了国际上验证过的预测模型是否会影响临床医生对去骨瓣减压术的决策。通过两次结构访谈，在了解到 6 个月时不良神经结局的预测风险之前和之后进行，评估了参与者对 3 名严重创伤性脑损伤患者进行去骨瓣减压术的建议。当没有替代决策人时，当近亲要求手术干预时，当患者有预先指示时，以及当参与者是受伤方时，参与者会对其进行评分。使用视觉模拟量表（1-10）来评估他们意见的强度。共有 50 名神经外科医生和重症监护医生参与了这项研究。与自己相比，参与者更有可能为患者推荐去骨瓣减压术，尤其是当患者的近亲要求进行该手术时，并且与有预先指示的患者相比，他们的自身偏好更相似。在了解到不良结果的预测风险后，临床医生对为自己和患者进行该手术的意愿明显降低，并且这种态度的变化在不同专业的医生中是一致的，而与照顾类似患者的经验量或宗教背景无关。总之，不良结果的预测风险影响了临床医生对严重神经创伤患者推荐去骨瓣减压术的决策。
