Severe Acute Brain Injury

  • Margaret IsaacEmail author
  • Claire J. Creutzfeldt


Severe acute brain injury (SABI) is a heterogeneous group of diseases that leave patients acutely neurologically devastated. This chapter discusses the unique challenges that clinicians face when caring for patients with SABI and their families with a focus on the acute setting, when shared decision making is challenged by significant prognostic uncertainty and the need for grieving family members to consider patient’s goals of care. Clinicians practicing in the emergency department, acute neurology or neuro-critical care setting need to master a set of distinct palliative care skills to help patients and families navigate the severe acute brain injury landscape. These skills are relevant to all clinicians, providing both primary and specialist palliative care. Using a case example, we provide recommendations regarding symptom management and caregiver support in the acute and chronic setting, and discuss communication skills for clinicians engaging with family members, especially around prognosis and treatment goals. Research and education needs in this area of palliative care are substantial.


Severe acute brain injury (SABI) Stroke Subarachnoid hemorrhage Post-anoxic encephalopathy Traumatic brain injury (TBI) Family conferences Goals of care Symptom management Prognostication Withdrawal of life support 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medicine, and Palliative Care ServiceUniversity of Washington School of Medicine/Harborview Medical CenterSeattleUSA
  2. 2.Department of NeurologyUniversity of Washington Harborview Medical CenterSeattleUSA

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