Magnetic resonance imaging (MRI) and prognostication in neonatal hypoxic-ischemic injury: a vignette-based study of Canadian specialty physicians.
Magnetic resonance imaging (MRI) could improve prognostication in neonatal brain injury; however, factors beyond technical or scientific refinement may impact its use and interpretation. We surveyed Canadian neonatologists and pediatric neurologists using general and vignette-based questions about the use of MRI for prognostication in neonates with hypoxic-ischemic injury. There was inter- and intra-vignette variability in prognosis and in ratings about the usefulness of MRI. Severity of predicted outcome correlated with certainty about the outcome. A majority of physicians endorsed using MRI results in discussing prognosis with families, and most suggested that MRI results contribute to end-of-life decisions. Participating neonatologists, when compared to participating pediatric neurologists, had significantly less confidence in the interpretation of MRI by colleagues in neurology and radiology. Further investigation is needed to understand the complexity of MRI and of its application. Potential gaps relative to our understanding of the ethical importance of these findings should be addressed.
Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada Emily.bell@ircm.qc.ca.
Emily
E
Bell
McGill University, Montreal, Quebec, Canada.
Lisa Anne
LA
Rasmussen
Jewish Rehabilitation Hospital of Laval, Laval, Quebec, Canada.
Barbara
B
Mazer
McGill University, Montreal, Quebec, Canada.
Michael
M
Shevell
University of Toronto, Toronto, Ontario, Canada.
Steven P
SP
Miller
University of British Columbia, Vancouver, British Columbia, Canada.
Anne
A
Synnes
University of Alberta, Edmonton, Alberta, Canada.
Jerome Y
JY
Yager
McGill University, Montreal, Quebec, Canada.
Annette
A
Majnemer
University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Nazeem
N
Muhajarine
Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada.
Isabelle
I
Chouinard
Institut de recherches cliniques de Montréal, Montreal, Quebec, Canada McGill University, Montreal, Quebec, Canada Université de Montréal, Montréal, Quebec, Canada.
Eric
E
Racine
D002170:Canada; D005260:Female; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D009462:Neurology / Q000379:methods; D010820:Physicians / Q000523:psychology; D011379:Prognosis; D013997:Time Factors
decision making; ethics; magnetic resonance imaging; neonatal hypoxic-ischemic encephalopathy; prognostication