Carhuapoma Lourdes R, Hwang David Y
Department of Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA.
Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Neurocrit Care. 2024 Dec 3. doi: 10.1007/s12028-024-02170-4.
Prognostication is fundamental to determining the intensity of care offered for many critically ill patients with severe acute brain injury (SABI). Inherent uncertainties linked to predicting outcomes for patients with SABI primarily arise from a lack of complete data regarding the natural disease/injury progression that follows various forms of SABI, stemming from early withdrawal of life-sustaining treatment. This potential bias has led to limitations in using outcome data associated with clinical grading scales and a risk of perpetuating high mortality following SABI, leading to self-fulfilling prophecies. The aims of this article are to (1) review contemporary prognostication practices among clinicians for patients with SABI, (2) discuss inherent challenges in prognosticating outcomes following SABI, (3) summarize statements and guidelines from professional societies regarding SABI prognostication, and (4) identify directions for future research in prognostication after SABI.
对于许多患有严重急性脑损伤（SABI）的重症患者，预后评估是确定所提供治疗强度的基础。与预测SABI患者预后相关的内在不确定性主要源于缺乏关于各种形式SABI后自然疾病/损伤进展的完整数据，这源于生命维持治疗的早期撤除。这种潜在的偏差导致在使用与临床分级量表相关的结局数据时存在局限性，并存在SABI后高死亡率持续存在的风险，从而导致自我实现的预言。本文的目的是：（1）回顾临床医生对SABI患者的当代预后评估实践；（2）讨论SABI后预后评估中存在的固有挑战；（3）总结专业协会关于SABI预后评估的声明和指南；（4）确定SABI后预后评估未来研究的方向。
