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To Treat or Not to Treat: Early Withdrawal of Therapy and the Limits of Prognostic Ability

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Controversies in Severe Traumatic Brain Injury Management

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Abstract

The development of computed tomography (CT), simple classifications of the severity of traumatic brain injury such as the Glasgow Coma Scale, monitoring of intracranial pressure, and the concept of prevention of secondary brain injury have helped advance the ability to prognosticate and improve outcomes after traumatic brain injury. However, the art of determining prognosis after severe traumatic brain injury remains imprecise in many situations, leading to controversy over which patients may benefit from aggressive treatment and which patients may suffer futile outcomes despite intervention. A 2005 survey found that 80% of physicians thought that an accurate prognostic assessment was required for decisions on whether or not to withdraw treatment, but only around a third felt that they could accurately assess prognosis.

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Authors and Affiliations

  1. Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA

    Young Lee MD, Angel Ordaz BS & Geoffrey T. Manley MD, PhD

  2. Department of Neurological Surgery, Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA

    Michael Huang MD & Geoffrey T. Manley MD, PhD

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  1. Young Lee MD
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  2. Angel Ordaz BS
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  3. Michael Huang MD
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  4. Geoffrey T. Manley MD, PhD
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Correspondence to Geoffrey T. Manley MD, PhD .

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Editors and Affiliations

  1. Department of Neurosurgery, Penn State University Milton S. Hershey Medical Center, Hershey, PA, USA

    Shelly D. Timmons

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Lee, Y., Ordaz, A., Huang, M., Manley, G.T. (2018). To Treat or Not to Treat: Early Withdrawal of Therapy and the Limits of Prognostic Ability. In: Timmons, S. (eds) Controversies in Severe Traumatic Brain Injury Management. Springer, Cham. https://doi.org/10.1007/978-3-319-89477-5_2

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  • DOI: https://doi.org/10.1007/978-3-319-89477-5_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-89476-8

  • Online ISBN: 978-3-319-89477-5

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