Prognostication Strategy
At the 2017 International Symposium on Intensive Care and Emergency Medicine, the experts in this field suggested a strategy for the treating physicians.
The key principles of this strategy are:
- Early Communication with the next of kin
It is important to provide early on a meaningful information and make them aware of patient’s critical condition. This helps the physician to understand the expectations, but it is vital to convey that physicians will take decision in the best interest of the patient.
- Delay the timing of prognostication
The current recommendations are to consider prognosis at 24 or 72 hours depending on patient not receiving or receiving temperature management. The phenomenon of ‘late awakening’ has been observed and an extremely small number of patients who do not respond for 5-7 days recover with intact neurology.
- Use of Multimodal Evaluation tool for prognostication
It is highly recommended for the physicians to use clinical examination, electrophysiological tests, biochemical markers and radiological tests while considering neuro-prognostication. This is discussed subsequently in further detail.
- Be patient
This a key attribute and the treating physician should approach individual cases differently but follow the suggested principles. There is no harm in involving your fellow colleagues in the decision-making process.