title: Determination of neurologic prognosis and clinical decision making in adult patients with severe traumatic brain injury: a survey of Canadian intensivists, neurosurgeons, and neurologists.
abstract: OBJECTIVE
  Accurate prognostic information in patients with severe traumatic brain injury remains limited, but mortality following the withdrawal of life-sustaining therapies is high and variable across centers. We designed a survey to understand attitudes of physicians caring for patients with severe traumatic brain injury toward the determination of prognosis and clinical decision making on the level of care.
  
  
  METHODS
  We conducted a cross-sectional study of intensivists, neurosurgeons, and neurologists that participate in the care of patients with severe traumatic brain injury at all Canadian level 1 and level 2 trauma centers.
  
  
  METHODS
  None.
  
  
  METHODS
  The main outcome measure was physicians' perceptions of prognosis and recommendations on the level of care.
  
  
  RESULTS
  Our response rate was 64% (455/712). Most respondents (65%) reported that an accurate prediction of prognosis would be most helpful during the first 7 days. Most respondents (>80%) identified bedside monitoring, clinical exam, and imaging to be useful for evaluating prognosis, whereas fewer considered electrophysiology tests (<60%) and biomarkers (<15%). In a case-based scenario, approximately one-third of respondents agreed, one-third were neutral, and one-third disagreed that the patient prognosis would be unfavorable at one year. About 10% were comfortable recommending withdrawal of life-sustaining therapies.
  
  
  CONCLUSIONS
  A significant variation in perceptions of neurologic prognosis and in clinical decision making on the level of care was found among Canadian intensivists, neurosurgeons, and neurologists. Improved understanding of the factors that can accurately predict prognosis for patients with traumatic brain injury is urgently needed.
authors: Centre de Recherche FRQ-S du CHU de Québec-Hôpital de l'Enfant-Jésus, Traumatologie-Urgence-Soins Intensifs (CHU de Québec Research Center [Enfant-Jésus Hospital] Trauma-Emergency-Critical Care Medicine Unit), Université Laval, Québec City, QC, Canada. alexis.turgeon@fmed.ulaval.ca
authors: Alexis F
authors: AF
authors: Turgeon
authors: François
authors: F
authors: Lauzier
authors: Karen E A
authors: KE
authors: Burns
authors: Maureen O
authors: MO
authors: Meade
authors: Damon C
authors: DC
authors: Scales
authors: Ryan
authors: R
authors: Zarychanski
authors: Lynne
authors: L
authors: Moore
authors: David A
authors: DA
authors: Zygun
authors: Lauralyn A
authors: LA
authors: McIntyre
authors: Salmaan
authors: S
authors: Kanji
authors: Paul C
authors: PC
authors: Hébert
authors: Valérie
authors: V
authors: Murat
authors: Giuseppe
authors: G
authors: Pagliarello
authors: Dean A
authors: DA
authors: Fergusson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy*; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data*; D009493:Neurosurgery / Q000706:statistics & numerical data*; D010819:Physician's Role; D010820:Physicians / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology