Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Nat Rev Neurol. 2022 Jul;18(7):419-427. doi: 10.1038/s41582-022-00644-7. Epub 2022 Mar 29.
Neuroprognostication, or the prediction of recovery from disorders of consciousness caused by severe brain injury, is as critical as it is complex. With profound implications for mortality and quality of life, neuroprognostication draws upon an intricate set of biomedical, probabilistic, psychosocial and ethical factors. However, the clinical approach to neuroprognostication is often unsystematic, and consequently, variable among clinicians and prone to error. Here, we offer a stepwise conceptual framework for reasoning through neuroprognostic determinations - including an evaluation of neurological function, estimation of a recovery trajectory, definition of goals of care and consideration of patient values - culminating in a clinically actionable formula for weighing the risks and benefits of life-sustaining treatment. Although the complexity of neuroprognostication might never be fully reducible to arithmetic, this systematic approach provides structure and guidance to supplement clinical judgement and direct future investigation.
神经预后预测，即预测严重脑损伤引起的意识障碍患者的恢复情况，至关重要且复杂。神经预后预测对死亡率和生活质量有着深远的影响，它涉及到一系列复杂的生物医学、概率、心理社会和伦理因素。然而，神经预后预测的临床方法往往是非系统的，因此，不同临床医生之间存在差异，容易出现错误。在这里，我们提供了一个逐步的概念框架，用于推理神经预后判断，包括对神经功能的评估、对恢复轨迹的估计、对护理目标的定义以及对患者价值观的考虑，最终形成了一个用于权衡维持生命治疗的风险和收益的临床可操作公式。尽管神经预后预测的复杂性可能永远无法完全简化为算术，但这种系统方法提供了结构和指导，以补充临床判断并指导未来的研究。
