Research Letter: Surveying Clinician Variability in Neuro-Prognostication for Patients With Severe Traumatic Brain Injury.

OBJECTIVE

To describe the approach to, accuracy, and variability of neuro-prognostication for patients with severe traumatic brain injury (TBI) among clinicians caring for these patients.

SETTING

Data were collected via an anonymous electronic survey.

PARTICIPANTS

The survey was emailed to all clinicians who care for patients with TBI at a Level 1 Trauma Center.

DESIGN

In this observational survey study, respondents were provided vignettes of 3 real patients with TBI and asked to predict 2-year Glasgow Outcome Scale-Extended (GOS-E) scores and 6-month risk of mortality and unfavorable outcome (GOS-E <4). Medical management decisions and approach to goals of care discussions were queried. Results were collected anonymously.

MAIN MEASURES: Primary outcome measure was prognostic variability. Secondary outcome measures included overall prognostic accuracy and incidence of management recommendations overall and by clinical role.

RESULTS

Of the 55 respondents, 16 (29%) were attending physicians, 19 (35%) residents or fellows, 6 (11%) advanced practice providers, and 14 (25%) nurses. The accuracy of prognostication based on initial patient presentation was 15%. The range of responses for predicted outcome for each patient spanned all GOS-E scores (1-8), and responses for predicted probability of 6-month mortality ranged from 0% to 99% for each patient.

CONCLUSION

Prognostication accuracy was low, and predictions were highly variable, including all possible neurologic outcomes and mortality ranges. Decreasing the variability in neuro-prognostication for patients with severe TBI is critical.