Gap Analysis Regarding Prognostication in Neurocritical Care: A Joint Statement from the German Neurocritical Care Society and the Neurocritical Care Society

Katja E. Wartenberg, David Y. Hwang, Karl Georg Häusler, Susanne Muehlschlegel, Oliver W. Sakowitz, Dominik Madžar, Hajo M. Hamer, Alejandro A. Rabinstein, David M. Greer, J. Claude Hemphill, Juergen Meixensberger, Panayiotis N. Varelas

Research output: Contribution to journalArticle

Abstract

Background/Objective: Prognostication is a routine part of the delivery of neurocritical care for most patients with acute neurocritical illnesses. Numerous prognostic models exist for many different conditions. However, there are concerns about significant gaps in knowledge regarding optimal methods of prognostication. Methods: As part of the Arbeitstagung NeuroIntensivMedizin meeting in February 2018 in Würzburg, Germany, a joint session on prognostication was held between the German NeuroIntensive Care Society and the Neurocritical Care Society. The purpose of this session was to provide presentations and open discussion regarding existing prognostic models for eight common neurocritical care conditions (aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, traumatic brain injury, traumatic spinal cord injury, status epilepticus, Guillain–Barré Syndrome, and global cerebral ischemia from cardiac arrest). The goal was to develop a qualitative gap analysis regarding prognostication that could help inform a future framework for clinical studies and guidelines. Results: Prognostic models exist for all of the conditions presented. However, there are significant gaps in prognostication in each condition. Furthermore, several themes emerged that crossed across several or all diseases presented. Specifically, the self-fulfilling prophecy, lack of accounting for medical comorbidities, and absence of integration of in-hospital care parameters were identified as major gaps in most prognostic models. Conclusions: Prognostication in neurocritical care is important, and current prognostic models are limited. This gap analysis provides a summary assessment of issues that could be addressed in future studies and evidence-based guidelines in order to improve the process of prognostication.

Original languageEnglish (US)
JournalNeurocritical care
DOIs
StateAccepted/In press - Jan 1 2019

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Guidelines
Status Epilepticus
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Heart Arrest
Brain Ischemia
Spinal Cord Injuries
Germany
Comorbidity
Patient Care
Joints
Stroke
Clinical Studies
Traumatic Brain Injury

Keywords

  • Comorbidities
  • Outcome predictors
  • Prognostication
  • Self-fulfilling prophecy

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Gap Analysis Regarding Prognostication in Neurocritical Care : A Joint Statement from the German Neurocritical Care Society and the Neurocritical Care Society. / Wartenberg, Katja E.; Hwang, David Y.; Häusler, Karl Georg; Muehlschlegel, Susanne; Sakowitz, Oliver W.; Madžar, Dominik; Hamer, Hajo M.; Rabinstein, Alejandro A.; Greer, David M.; Hemphill, J. Claude; Meixensberger, Juergen; Varelas, Panayiotis N.

In: Neurocritical care, 01.01.2019.

Research output: Contribution to journalArticle

Wartenberg, KE, Hwang, DY, Häusler, KG, Muehlschlegel, S, Sakowitz, OW, Madžar, D, Hamer, HM, Rabinstein, AA, Greer, DM, Hemphill, JC, Meixensberger, J & Varelas, PN 2019, 'Gap Analysis Regarding Prognostication in Neurocritical Care: A Joint Statement from the German Neurocritical Care Society and the Neurocritical Care Society', Neurocritical care. https://doi.org/10.1007/s12028-019-00769-6
Wartenberg, Katja E. ; Hwang, David Y. ; Häusler, Karl Georg ; Muehlschlegel, Susanne ; Sakowitz, Oliver W. ; Madžar, Dominik ; Hamer, Hajo M. ; Rabinstein, Alejandro A. ; Greer, David M. ; Hemphill, J. Claude ; Meixensberger, Juergen ; Varelas, Panayiotis N. / Gap Analysis Regarding Prognostication in Neurocritical Care : A Joint Statement from the German Neurocritical Care Society and the Neurocritical Care Society. In: Neurocritical care. 2019.
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abstract = "Background/Objective: Prognostication is a routine part of the delivery of neurocritical care for most patients with acute neurocritical illnesses. Numerous prognostic models exist for many different conditions. However, there are concerns about significant gaps in knowledge regarding optimal methods of prognostication. Methods: As part of the Arbeitstagung NeuroIntensivMedizin meeting in February 2018 in W{\"u}rzburg, Germany, a joint session on prognostication was held between the German NeuroIntensive Care Society and the Neurocritical Care Society. The purpose of this session was to provide presentations and open discussion regarding existing prognostic models for eight common neurocritical care conditions (aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, traumatic brain injury, traumatic spinal cord injury, status epilepticus, Guillain–Barr{\'e} Syndrome, and global cerebral ischemia from cardiac arrest). The goal was to develop a qualitative gap analysis regarding prognostication that could help inform a future framework for clinical studies and guidelines. Results: Prognostic models exist for all of the conditions presented. However, there are significant gaps in prognostication in each condition. Furthermore, several themes emerged that crossed across several or all diseases presented. Specifically, the self-fulfilling prophecy, lack of accounting for medical comorbidities, and absence of integration of in-hospital care parameters were identified as major gaps in most prognostic models. Conclusions: Prognostication in neurocritical care is important, and current prognostic models are limited. This gap analysis provides a summary assessment of issues that could be addressed in future studies and evidence-based guidelines in order to improve the process of prognostication.",
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AU - Hwang, David Y.

AU - Häusler, Karl Georg

AU - Muehlschlegel, Susanne

AU - Sakowitz, Oliver W.

AU - Madžar, Dominik

AU - Hamer, Hajo M.

AU - Rabinstein, Alejandro A.

AU - Greer, David M.

AU - Hemphill, J. Claude

AU - Meixensberger, Juergen

AU - Varelas, Panayiotis N.

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N2 - Background/Objective: Prognostication is a routine part of the delivery of neurocritical care for most patients with acute neurocritical illnesses. Numerous prognostic models exist for many different conditions. However, there are concerns about significant gaps in knowledge regarding optimal methods of prognostication. Methods: As part of the Arbeitstagung NeuroIntensivMedizin meeting in February 2018 in Würzburg, Germany, a joint session on prognostication was held between the German NeuroIntensive Care Society and the Neurocritical Care Society. The purpose of this session was to provide presentations and open discussion regarding existing prognostic models for eight common neurocritical care conditions (aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, traumatic brain injury, traumatic spinal cord injury, status epilepticus, Guillain–Barré Syndrome, and global cerebral ischemia from cardiac arrest). The goal was to develop a qualitative gap analysis regarding prognostication that could help inform a future framework for clinical studies and guidelines. Results: Prognostic models exist for all of the conditions presented. However, there are significant gaps in prognostication in each condition. Furthermore, several themes emerged that crossed across several or all diseases presented. Specifically, the self-fulfilling prophecy, lack of accounting for medical comorbidities, and absence of integration of in-hospital care parameters were identified as major gaps in most prognostic models. Conclusions: Prognostication in neurocritical care is important, and current prognostic models are limited. This gap analysis provides a summary assessment of issues that could be addressed in future studies and evidence-based guidelines in order to improve the process of prognostication.

AB - Background/Objective: Prognostication is a routine part of the delivery of neurocritical care for most patients with acute neurocritical illnesses. Numerous prognostic models exist for many different conditions. However, there are concerns about significant gaps in knowledge regarding optimal methods of prognostication. Methods: As part of the Arbeitstagung NeuroIntensivMedizin meeting in February 2018 in Würzburg, Germany, a joint session on prognostication was held between the German NeuroIntensive Care Society and the Neurocritical Care Society. The purpose of this session was to provide presentations and open discussion regarding existing prognostic models for eight common neurocritical care conditions (aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, acute ischemic stroke, traumatic brain injury, traumatic spinal cord injury, status epilepticus, Guillain–Barré Syndrome, and global cerebral ischemia from cardiac arrest). The goal was to develop a qualitative gap analysis regarding prognostication that could help inform a future framework for clinical studies and guidelines. Results: Prognostic models exist for all of the conditions presented. However, there are significant gaps in prognostication in each condition. Furthermore, several themes emerged that crossed across several or all diseases presented. Specifically, the self-fulfilling prophecy, lack of accounting for medical comorbidities, and absence of integration of in-hospital care parameters were identified as major gaps in most prognostic models. Conclusions: Prognostication in neurocritical care is important, and current prognostic models are limited. This gap analysis provides a summary assessment of issues that could be addressed in future studies and evidence-based guidelines in order to improve the process of prognostication.

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KW - Self-fulfilling prophecy

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