Prognosis in TBI – a hard nut to crack


Synopsis

Stuart Duffin is an intensive care doctor & anaesthetist working in Stockholm, Sweden. In this talk from #SWEETS17 he looks at the difficulties front line clinicians face when predicting prognosis in severe traumatic brain injury. How can we possibly be able to look reliably into the future to allow us to make the right decisions? How can we avoid falling into the fallacy of the self fullfilling prophecy and not even knowing it?

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References

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Chestnut RM, Ghajar J, Maas AI, et al. Part 2: Early indicators of prognosis in severe traumatic brain injury. Journal of Neurotrauma 2000; 17: 555–555. [Source]
2
Collaborators MCT, Perel P, Arango M, et al. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ (Clinical research ed) 2008; 336: 425–9. [PubMed]
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Steyerberg EW, Mushkudiani N, Perel P, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS medicine 2008; 5: e165; discussion e165. [PubMed]
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Hemphill JC, White DB. Clinical nihilism in neuroemergencies. Emergency medicine clinics of North America 2009; 27: 27–37, vii–viii. [PubMed]
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Nelson DW, Nystr\om H, MacCallum RM, et al. Extended analysis of early computed tomography scans of traumatic brain injured patients and relations to outcome. Journal of neurotrauma 2010; 27: 51–64. [PubMed]
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Izzy S, Compton R, Carandang R, Hall W, Muehlschlegel S. Self-fulfilling prophecies through withdrawal of care: do they exist in traumatic brain injury, too? Neurocritical care 2013; 19: 347–63. [PubMed]
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Thelin EP, Johannesson L, Nelson D, Bellander B-M. S100B is an important outcome predictor in traumatic brain injury. Journal of neurotrauma 2013; 30: 519–28. [PubMed]
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Scotter J, Hendrickson S, Marcus HJ, Wilson MH. Prognosis of patients with bilateral fixed dilated pupils secondary to traumatic extradural or subdural haematoma who undergo surgery: a systematic review and meta-analysis. Emergency medicine journal : EMJ 2015; 32: 654–9. [PubMed]
9
Sandsmark DK. Clinical Outcomes after Traumatic Brain Injury. Current neurology and neuroscience reports 2016; 16: 52. [PubMed]
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Carney N, Totten AM, O’Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 2017; 80: 6–15. [PubMed]
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Mads Astvad
Scandinavian anaesthetist. PHARM, ED, OR, ICU. Special interest in wee patients.