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Related Concept Videos

Traumatic Brain Injury l: Introduction01:28

Traumatic Brain Injury l: Introduction

DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...

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Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
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Guidelines for Neuroprognostication in Critically Ill Adults with Moderate-Severe Traumatic Brain Injury.

Susanne Muehlschlegel1, Venkatakrishna Rajajee2, Katja E Wartenberg3

  • 1Departments of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Neurocritical Care
|February 17, 2024
PubMed
Summary

Accurate neuroprognostication in moderate-severe traumatic brain injury (msTBI) relies on specific predictors and models. Bilateral nonreactive pupils and CRASH/IMPACT models offer moderate reliability for predicting outcomes.

Keywords:
Neurocritical careOutcomePrognosisPrognosticationTraumatic brain injury

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Area of Science:

  • Neuroscience
  • Clinical Medicine
  • Public Health

Background:

  • Moderate-severe traumatic brain injury (msTBI) is a significant global health concern.
  • Accurate neuroprognostication is critical for clinical decision-making in msTBI.
  • This study provides guidance on the reliability of predictors and models for msTBI neuroprognostication.

Purpose of the Study:

  • To systematically review and provide recommendations on the reliability of clinical predictors and prediction models for msTBI.
  • To guide clinicians in counseling surrogate decision-makers regarding patient prognosis.
  • To establish best practices for neuroprognostication in msTBI.

Main Methods:

  • A systematic narrative review using the GRADE methodology.
  • Framed PICOTS questions and applied stringent full-text screening.
  • Focused on evidence quality, outcome desirability, values, preferences, and resource use.

Main Results:

  • 41 articles were selected from 8125 screened.
  • Bilateral nonreactive pupils (uncomplicated) showed moderate reliability for predicting 6-month outcomes/mortality.
  • CRASH and IMPACT prediction models were moderately reliable for predicting mortality and functional outcomes.

Conclusions:

  • Guidelines are provided on the reliability of predictors and models for msTBI.
  • Clinicians should acknowledge substantial uncertainty when using these tools.
  • Broad principles for neuroprognostication in msTBI are suggested.