Clinicians' Approaches to Prognostication After Traumatic Brain Injury and Cardiac Arrest: A Multi-Hospital,...

Area of Science:

• Neuroscience
• Clinical Medicine
• Medical Prognostication

Background:

• Understanding clinical prognostication is crucial for improving patient care and clinical trial design.
• This study compares clinician prognostication approaches in traumatic brain injury (TBI) and cardiac arrest (CA) patients.

Purpose of the Study:

• To compare how clinicians prognosticate for patients with severe traumatic brain injury (TBI) versus those who experienced cardiac arrest (CA).
• To identify differences in reliance on initial clinical judgment versus later assessments in TBI and CA prognostication.

Main Methods:

• Semi-structured interviews were conducted with clinicians treating TBI patients in the BOOST-3 trial.
• Interview data were compared with a previous study of CA patients in the ICECAP trial.
• Deductive and inductive coding were used to analyze reliance on initial clinical gestalt and other prognostic factors.

Main Results:

• Fewer clinicians reported using initial "clinical gestalt" for TBI (22%) compared to CA (70%).
• Prognostication occurred later for TBI cases (7 days IQR) than CA cases (3 days IQR).
• Clinicians reported higher confidence in initial CA prognostication (40%) than TBI (33%).

Conclusions:

• Clinicians are less likely to rely on initial impressions for TBI prognostication than for CA.
• Later subjective assessments are more frequently used to refine uncertain TBI prognoses.
• Initial prognostic confidence is lower for TBI patients compared to CA patients.