Impact of MRI on decision-making in ICU patients with disorders of consciousness
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Impact of MRI on decision-making in ICU patients with disorders of consciousness. / Albrechtsen, Simon S.; Riis, Robert G.C.; Amiri, Moshgan; Tanum, Gry; Bergdal, Ove; Blaabjerg, Morten; Simonsen, Claus Z.; Kondziella, Daniel.
In: Behavioural Brain Research, Vol. 421, 113729, 2022.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Impact of MRI on decision-making in ICU patients with disorders of consciousness
AU - Albrechtsen, Simon S.
AU - Riis, Robert G.C.
AU - Amiri, Moshgan
AU - Tanum, Gry
AU - Bergdal, Ove
AU - Blaabjerg, Morten
AU - Simonsen, Claus Z.
AU - Kondziella, Daniel
N1 - Publisher Copyright: © 2022
PY - 2022
Y1 - 2022
N2 - Background: Recovery of consciousness is the most important survival factor in patients with acute brain injury and disorders of consciousness (DoC). Since most deaths in the intensive care unit (ICU) occur after withdrawal of life-support, medical decision-making is crucial for acute DoC patients. Neuroimaging informs decision-making, yet the precise effects of MRI on decision-making in the ICU are poorly understood. We investigated the impact of brain MRI on prognostication, therapeutic decisions and physician confidence in ICU patients with DoC. Methods: In this simulated decision-making study utilizing a prospective ICU cohort, a panel of neurocritical experts first reviewed clinical information (without MRI) from 75 acute DoC patients and made decisions about diagnosis, prognosis and treatment. Following review of the MRI, the panel then decided if the initial decisions needed revision. In parallel, a blinded neuroradiologist reassessed all neuroimaging. Results: MRI led to changes in clinical management of 57 (76%) of patients (Number-Needed-to-Test for any change: 1.32), including revised diagnoses (20%), levels of care (21%), diagnostic confidence (43%) and prognostications (33%). Decisions were revised more often with stroke than with other brain injuries (p = 0.02). However, although MRI revealed additional pathology in 81%, this did not predict revised clinical decision-making (p-values ≥0.08). Conclusion: MRI results changed decision-making in 3 of 4 ICU patients, but radiological findings were not predictive of clinical decision-making. This highlights the need to better understand the effects of neuroimaging on management decisions. How MRI influences decision-making in the ICU is an important avenue for research to improve acute DoC management.
AB - Background: Recovery of consciousness is the most important survival factor in patients with acute brain injury and disorders of consciousness (DoC). Since most deaths in the intensive care unit (ICU) occur after withdrawal of life-support, medical decision-making is crucial for acute DoC patients. Neuroimaging informs decision-making, yet the precise effects of MRI on decision-making in the ICU are poorly understood. We investigated the impact of brain MRI on prognostication, therapeutic decisions and physician confidence in ICU patients with DoC. Methods: In this simulated decision-making study utilizing a prospective ICU cohort, a panel of neurocritical experts first reviewed clinical information (without MRI) from 75 acute DoC patients and made decisions about diagnosis, prognosis and treatment. Following review of the MRI, the panel then decided if the initial decisions needed revision. In parallel, a blinded neuroradiologist reassessed all neuroimaging. Results: MRI led to changes in clinical management of 57 (76%) of patients (Number-Needed-to-Test for any change: 1.32), including revised diagnoses (20%), levels of care (21%), diagnostic confidence (43%) and prognostications (33%). Decisions were revised more often with stroke than with other brain injuries (p = 0.02). However, although MRI revealed additional pathology in 81%, this did not predict revised clinical decision-making (p-values ≥0.08). Conclusion: MRI results changed decision-making in 3 of 4 ICU patients, but radiological findings were not predictive of clinical decision-making. This highlights the need to better understand the effects of neuroimaging on management decisions. How MRI influences decision-making in the ICU is an important avenue for research to improve acute DoC management.
KW - Cardiac arrest
KW - Coma
KW - Prognostication
KW - Stroke
KW - Subarachnoid hemorrhage
KW - Traumatic brain injury
KW - Unresponsive wakefulness syndrome
KW - Vegetative state
U2 - 10.1016/j.bbr.2021.113729
DO - 10.1016/j.bbr.2021.113729
M3 - Journal article
C2 - 34973968
AN - SCOPUS:85122358778
VL - 421
JO - Behavioural Brain Research
JF - Behavioural Brain Research
SN - 0166-4328
M1 - 113729
ER -
ID: 290109728