Absolutely no hope? Some ambiguity of futility of care in devastating acute stroke.
OBJECTIVE
Devastating stroke can produce irreversible brain damage of massive proportions. In those patients, continuation of aggressive medical or surgical care may be futile and may unnecessarily prolong the suffering of families. Therefore, it is essential for clinicians to be aware of key clinical and radiologic features predictive of poor outcome. There has not been a critical review of the data used to make decisions of withdrawal of care in patients with severe strokes.


METHODS
Literature review.


RESULTS
Although in many instances the studies that validate these prognosticators represent class III or class IV evidence, there are several clinico-radiologic profiles that have consistently been predictive of mortality or dependency after cerebrovascular catastrophes.


CONCLUSIONS
Inconclusiveness remains in the determination of futility of care after major stroke. However, predictors of dismal outcome after several types of stroke have been identified and are relevant information in regard to withdrawal of care.
Wijdicks
Eelco F M
EF
Neurological-Neurosurgical Intensive Care Unit, Saint Marys, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. wijde@mayo.edu
Rabinstein
Alejandro A
AA
D000208:Acute Disease; D002543:Cerebral Hemorrhage / Q000150:complications; D002544:Cerebral Infarction / Q000150:complications; D003422:Critical Care / Q000379:methods; D003657:Decision Making; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D018447:Medical Futility / Q000941:ethics / Q000523:psychology; D009460:Neurologic Examination / Q000379:methods / Q000592:standards; D017063:Outcome Assessment, Health Care; D010819:Physician's Role; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012107:Research Design; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000150:complications; D016896:Treatment Outcome; D028761:Withholding Treatment