Neurocritical Care

, 11:345 | Cite as

Profiles of Neurological Outcome Prediction Among Intensivists

  • Eric Racine
  • Marie-Josée Dion
  • Christine A. C. Wijman
  • Judy Illes
  • Maarten G. Lansberg
Original Article

Abstract

Background

Advances in intensive care medicine have increased survival rates of patients with critical neurological conditions. The focus of prognostication for such patients is therefore shifting from predicting chances of survival to meaningful neurological recovery. This study assessed the variability in long-term outcome predictions among physicians and aimed to identify factors that may account for this variability.

Methods

Based on a clinical vignette describing a comatose patient suffering from post-anoxic brain injury intensivists were asked in a semi-structured interview about the patient’s specific neurological prognosis and about prognostication in general. Qualitative research methods were used to identify areas of variability in prognostication and to classify physicians according to specific prognostication profiles. Quantitative statistics were used to assess for associations between prognostication profiles and physicians’ demographic and practice characteristics.

Results

Eighteen intensivists participated. Functional outcome predictions varied along an evaluative dimension (fair/good–poor) and a confidence dimension (certain–uncertain). More experienced physicians tended to be more pessimistic about the patient’s functional outcome and more certain of their prognosis. Attitudes toward quality of life varied along an evaluative dimension (good–poor) and a “style” dimension (objective–subjective). Older and more experienced physicians were more likely to express objective judgments of quality of life and to predict a worse quality of life for the patient than their younger and less experienced counterparts.

Conclusions

Various prognostication profiles exist among intensivists. These may be dictated by factors such as physicians’ age and clinical experience. Awareness of these associations may be a first step to more uniform prognostication.

Keywords

Prognosis Coma Critical care Ethics Neurology Neuroethics 

Supplementary material

12028_2009_9225_MOESM1_ESM.doc (29 kb)
Supplementary material 1 (DOC 29 kb)

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Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Eric Racine
    • 1
    • 2
    • 3
  • Marie-Josée Dion
    • 1
  • Christine A. C. Wijman
    • 4
    • 5
  • Judy Illes
    • 6
    • 7
    • 8
  • Maarten G. Lansberg
    • 4
    • 5
  1. 1.Neuroethics Research UnitInstitut de recherches cliniques de MontréalMontrealCanada
  2. 2.Department of MedicineUniversity of MontrealMontrealCanada
  3. 3.Department of Neurology and Neurosurgery and Biomedical Ethics UnitMcGill UniversityMontrealCanada
  4. 4.Department of Neurology and Neurological SciencesStanford UniversityStanfordUSA
  5. 5.Stanford Stroke CenterStanford UniversityStanfordUSA
  6. 6.Center for Biomedical EthicsStanford UniversityStanfordUSA
  7. 7.Department of PediatricsStanford UniversityStanfordUSA
  8. 8.National Core for NeuroethicsUniversity of British ColumbiaVancouverCanada

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