TY -的T1 -摩根富林明预后语言关键神经疾病神经学乔-神经病学SP - e558 LP - - 10.1212 / WNL e569做。首页0000000000207462六世- 101 - 5盟艾德琳戈斯AU -康妮Ge盟女巫克劳福德AU - Kelsey Goostrey盟Praewpannanrai Buddadhumaruk盟——凯瑟琳·l·脚腕AU -伯纳德•罗盟-香农卡森盟杰Steingrub AU -道格拉斯·b·白盟Susanne Muehlschlegel Y1 - 2023/08/01 UR - //www.ez-admanager.com/content/101/5/e558.abstract N2 -背景和目标没有循证指南讨论预后至关重要的神经系统疾病,但总的来说,专家建议临床医生沟通使用估计预后,如数值首页或定性的风险。知之甚少如何实际临床医生沟通预后严重神经系统疾病。我们的主要目标是描述临床预后语言用于神经系统疾病至关重要。我们另外探索预后之间语言不同预后是否域(例如,生存,认知)。方法我们进行了一项多中心横截面混合方法研究分析鉴定记录audio-recorded clinician-family会议需要重症监护患者的神经系统疾病(如脑出血、创伤性脑损伤,严重的中风)从7我们中心。两个程序员分配编码预后语言类型和域预后的临床预后。预后语言编码的概率(估计的结果发生的可能性,例如,“80%的生存”;“她可能会生存”)或非概率(描述结果没有提供可能性;例如,“她可能活不下去”)。 We applied univariate and multivariate binomial logistic regression to examine independent associations between prognostic language and domain of prognosis.Results We analyzed 43 clinician-family meetings for 39 patients with 78 surrogates and 27 clinicians. Clinicians made 512 statements about survival (median 0/meeting [interquartile range (IQR) 0–2]), physical function (median 2 [IQR 0–7]), cognition (median 2 [IQR 0–6]), and overall recovery (median 2 [IQR 1–4]). Most statements were nonprobabilistic (316/512 [62%]); 10 of 512 prognostic statements (2%) offered numeric estimates; and 21% (9/43) of family meetings only contained nonprobabilistic language. Compared with statements about cognition, statements about survival (odds ratio [OR] 2.50, 95% CI 1.01–6.18, p = 0.048) and physical function (OR 3.22, 95% 1.77–5.86, p < 0.001) were more frequently probabilistic. Statements about physical function were less likely to be uncertainty-based than statements about cognition (OR 0.34, 95% CI 0.17–0.66, p = 0.002).Discussion Clinicians preferred not to use estimates (either numeric or qualitative) when discussing critical neurologic illness prognosis, especially when they discussed cognitive outcomes. These findings may inform interventions to improve prognostic communication in critical neurologic illness.ICU=intensive care unit; IQR=interquartile range; IRB=institutional review board; OR=odds ratio; TBI=traumatic brain injury; WLST=withdrawal of life-sustaining therapy ER -