naa a22 4500 510799531 CHVBK 20180411083348.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12028-013-9925-z doi (NATIONALLICENCE)springer-10.1007/s12028-013-9925-z Self-Fulfilling Prophecies Through Withdrawal of Care: Do They Exist in Traumatic Brain Injury, Too? [Elektronische Daten] [Saef Izzy, Rebecca Compton, Raphael Carandang, Wiley Hall, Susanne Muehlschlegel] Objective: We examined factors associated with withdrawal of care (WOC) in moderate-severe traumatic brain injury (msTBI) patients, and how WOC may affect short-term mortality and receipt of neurosurgery. Variability in msTBI-related outcome prognostication by clinicians from different specialties was also assessed. Methods: Rates of WOC, factors associated with WOC, and the relation between WOC and in-hospital case-fatality rate (CFR) and neurosurgery were determined in 232 prospectively enrolled msTBI patients in the ongoing OPTIMISM Study at a level-1 trauma center. In a concomitant web-based survey with clinical vignettes, outcome prognostication comfort, treatment aggressiveness, and WOC recommendations were examined among 106 respondents from neurology, neurocritical care, neurosurgery, trauma and anesthesia/critical care. Results: The average age of the study sample was 53years, with a median Glasgow Coma Scale of 6. The in-hospital CFR was 36 and 68% of patients had WOC. Factors independently associated with WOC were advanced age, pupillary reactivity, lower intensive care unit-length-of-stay, pre- and in-hospital cardiac arrest, herniation, intracranial pressure crisis, and pre-existing endocrine disease. Inclusion of WOC in our multivariable regression model predicting in-hospital CFRs negated all other variables. Survey results suggested that in younger patients, some clinicians prognosticated overly pessimistically based upon data available at the time of presentation. Conclusion: In our msTBI cohort, WOC was the most important predictor of in-hospital mortality. We identified several important independent predictors of WOC. Large within-center variability in msTBI outcome prognostication with varying levels of possible clinical nihilism exists, which may form the basis of self-fulfilling prophecies. Springer Science+Business Media New York, 2013 Traumatic brain injury nationallicence Withdrawal of care nationallicence Prognostication nationallicence Self-fulfilling prophecies nationallicence Izzy Saef Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, Worcester, MA, USA aut Compton Rebecca Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, Worcester, MA, USA aut Carandang Raphael Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, Worcester, MA, USA aut Hall Wiley Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, Worcester, MA, USA aut Muehlschlegel Susanne Departments of Neurology (Neurocritical Care), Anesthesia/Critical Care and Surgery, University of Massachusetts Medical School, 55 Lake Ave North, 01655, Worcester, MA, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 347-363 1541-6933 19:3<347 2013 19 12028 https://doi.org/10.1007/s12028-013-9925-z text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9925-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Izzy Saef Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, Worcester, MA, USA aut NATIONALLICENCE 700 1- Compton Rebecca Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, Worcester, MA, USA aut NATIONALLICENCE 700 1- Carandang Raphael Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, Worcester, MA, USA aut NATIONALLICENCE 700 1- Hall Wiley Department of Neurology (Neurocritical Care), University of Massachusetts Medical School, Worcester, MA, USA aut NATIONALLICENCE 700 1- Muehlschlegel Susanne Departments of Neurology (Neurocritical Care), Anesthesia/Critical Care and Surgery, University of Massachusetts Medical School, 55 Lake Ave North, 01655, Worcester, MA, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 347-363 1541-6933 19:3<347 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer