Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
Lancet Neurol. 2014 May;13(5):515-24. doi: 10.1016/S1474-4422(14)70030-4. Epub 2014 Mar 25.
Most in-hospital deaths of patients with stroke, traumatic brain injury, or postanoxic encephalopathy after cardiac arrest occur after a decision to withhold or withdraw life-sustaining treatments. Decisions on treatment restrictions in these patients are generally complex and are based only in part on evidence from published work. Prognostic models to be used in this decision-making process should have a strong discriminative power. However, for most causes of acute brain injury, prognostic models are not sufficiently accurate to serve as the sole basis of decisions to limit treatment. These decisions are also complicated because patients often do not have the capacity to communicate their preferences. Additionally, surrogate decision makers might not accurately represent the patient's preferences. Finally, in the acute stage, prediction of how a patient would adapt to a life with major disability is difficult.
大多数因心脏骤停后中风、创伤性脑损伤或缺氧后脑病而住院的患者的死亡发生在决定停止或撤回维持生命的治疗之后。这些患者的治疗限制决定通常很复杂，并且仅部分基于已发表研究的证据。用于这一决策过程的预后模型应该具有较强的区分能力。然而，对于大多数急性脑损伤的原因，预后模型的准确性还不足以作为限制治疗的唯一依据。这些决定也很复杂，因为患者通常没有能力表达他们的偏好。此外，替代决策人可能无法准确代表患者的偏好。最后，在急性阶段，预测患者如何适应严重残疾的生活是很困难的。
