Neuroprognostication, or the prediction of recovery from disorders of consciousness caused by severe brain injury, is as critical as it is complex. With profound implications for mortality and quality of life, neuroprognostication draws upon an intricate set of biomedical, probabilistic, psychosocial and ethical factors. However, the clinical approach to neuroprognostication is often unsystematic, and consequently, variable among clinicians and prone to error. Here, we offer a stepwise conceptual framework for reasoning through neuroprognostic determinations — including an evaluation of neurological function, estimation of a recovery trajectory, definition of goals of care and consideration of patient values — culminating in a clinically actionable formula for weighing the risks and benefits of life-sustaining treatment. Although the complexity of neuroprognostication might never be fully reducible to arithmetic, this systematic approach provides structure and guidance to supplement clinical judgement and direct future investigation.
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The authors have received funding from the NIH National Institute of Neurological Disorders and Stroke (R25NS06574309, R21NS109627), the NIH Director’s Office (DP2HD101400), James S. McDonnell Foundation, the Tiny Blue Dot Foundation, and the National Institute on Disability, Independent Living and Rehabilitation Research (90DPTB0011).
The authors declare no competing interests.
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Fischer, D., Edlow, B.L., Giacino, J.T. et al. Neuroprognostication: a conceptual framework. Nat Rev Neurol 18, 419–427 (2022). https://doi.org/10.1038/s41582-022-00644-7
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