Guidelines for Neuroprognostication in Critically ill Adults with Acute Ischemic Stroke

Area of Science:

• Neurology
• Critical Care Medicine
• Evidence-Based Medicine

Background:

• Critically ill patients with acute ischemic stroke (AIS) require specialized care.
• Accurate neuroprognostication is crucial for guiding treatment and counseling surrogates.
• Existing prediction models and individual predictors need evaluation for reliability.

Purpose of the Study:

• To provide recommendations on the reliability of predictors for critically ill AIS patients.
• To identify broad principles of neuroprognostication in this population.
• To aid in counseling patients and their surrogates regarding functional outcomes.

Main Methods:

• A narrative systematic review using GRADE methodology.
• Selection of predictors based on clinical relevance and evidence.
• Framing PICOTS questions to assess predictor reliability for poor functional outcome at 3 months or later.

Main Results:

• 518 articles were reviewed to guide recommendations.
• Early neurological improvement (within 24h) is a moderately reliable predictor of good outcome.
• No other individual predictor reliably predicted mortality or functional outcome; multimodal assessment is recommended.

Conclusions:

• Guidelines offer principles for neuroprognostication in critically ill AIS patients.
• Recommendations address the reliability of outcome predictors for patient and surrogate counseling.
• Emphasizes avoiding premature prognostication and utilizing multimodal assessments.