Limits...
Access to reliable information about long-term prognosis influences clinical opinion on use of lifesaving intervention.

Honeybul S, Ho K, O'Hanlon S - PLoS ONE (2012)

Bottom Line: Five hundred healthcare workers with a wide variety of clinical backgrounds participated.Patients' preferences were more similar to patients who had advance directives.The participants' preferences to perform the procedure for themselves and their patients both significantly reduced after knowing the predicted risks of unfavourable outcomes, and the changes in attitude were consistent across different specialties, amount of experience in caring for similar patients, religious backgrounds, and positions in the specialty of the participants.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia, Australia. stephen.honeybul@health.wa.gov.au

ABSTRACT

Background: Decompressive craniectomy has been traditionally used as a lifesaving rescue treatment in severe traumatic brain injury (TBI). This study assessed whether objective information on long-term prognosis would influence healthcare workers' opinion about using decompressive craniectomy as a lifesaving procedure for patients with severe TBI.

Method: A two-part structured interview was used to assess the participants' opinion to perform decompressive craniectomy for three patients who had very severe TBI. Their opinion was assessed before and after knowing the predicted and observed risks of an unfavourable long-term neurological outcome in various scenarios.

Results: Five hundred healthcare workers with a wide variety of clinical backgrounds participated. The participants were significantly more likely to recommend decompressive craniectomy for their patients than for themselves (mean difference in visual analogue scale [VAS] -1.5, 95% confidence interval -1.3 to -1.6), especially when the next of kin of the patients requested intervention. Patients' preferences were more similar to patients who had advance directives. The participants' preferences to perform the procedure for themselves and their patients both significantly reduced after knowing the predicted risks of unfavourable outcomes, and the changes in attitude were consistent across different specialties, amount of experience in caring for similar patients, religious backgrounds, and positions in the specialty of the participants.

Conclusions: Access to objective information on risk of an unfavourable long-term outcome influenced healthcare workers' decision to recommend decompressive craniectomy, considered as a lifesaving procedure, for patients with very severe TBI.

Show MeSH

Related in: MedlinePlus

A fifty nine year old male had suffered a fall.Initial Glasgow coma score was recorded as six (Eye: 1, Motor: 4, Verbal response: 1). His right pupil was unreactive. Left pupil was reactive. There were no other injuries. CT scan of the brain revealed diffuse petechial haemorrhages, traumatic subarachnoid haemorrhage and non evacuated haematoma.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3285690&req=5

pone-0032375-g002: A fifty nine year old male had suffered a fall.Initial Glasgow coma score was recorded as six (Eye: 1, Motor: 4, Verbal response: 1). His right pupil was unreactive. Left pupil was reactive. There were no other injuries. CT scan of the brain revealed diffuse petechial haemorrhages, traumatic subarachnoid haemorrhage and non evacuated haematoma.

Mentions: In order to maintain consistency the data was presented in the same manner on each occasion. Initially participants were shown three clinical cases and were informed that the injury severity increased with each case (Figures 1, 2 and 3). The only other information regarding factors that may influence possible outcome was to highlight the initial GCS and pupillary reaction to light in each case. In all three cases the patients were intubated and ventilated in the intensive care unit and had uncontrolled and progressively worsening intracranial hypertension despite placement of a ventricular drain and maximal medical management. There was no cardiovascular instability and a repeat CT scan showed no changes. No specific information regarding outcome prediction was mentioned. Participants were not given information about the objective predicted risks of unfavourable outcomes, as estimated by the CRASH prediction model, in the first part of the structured interview.


Access to reliable information about long-term prognosis influences clinical opinion on use of lifesaving intervention.

Honeybul S, Ho K, O'Hanlon S - PLoS ONE (2012)

A fifty nine year old male had suffered a fall.Initial Glasgow coma score was recorded as six (Eye: 1, Motor: 4, Verbal response: 1). His right pupil was unreactive. Left pupil was reactive. There were no other injuries. CT scan of the brain revealed diffuse petechial haemorrhages, traumatic subarachnoid haemorrhage and non evacuated haematoma.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3285690&req=5

pone-0032375-g002: A fifty nine year old male had suffered a fall.Initial Glasgow coma score was recorded as six (Eye: 1, Motor: 4, Verbal response: 1). His right pupil was unreactive. Left pupil was reactive. There were no other injuries. CT scan of the brain revealed diffuse petechial haemorrhages, traumatic subarachnoid haemorrhage and non evacuated haematoma.
Mentions: In order to maintain consistency the data was presented in the same manner on each occasion. Initially participants were shown three clinical cases and were informed that the injury severity increased with each case (Figures 1, 2 and 3). The only other information regarding factors that may influence possible outcome was to highlight the initial GCS and pupillary reaction to light in each case. In all three cases the patients were intubated and ventilated in the intensive care unit and had uncontrolled and progressively worsening intracranial hypertension despite placement of a ventricular drain and maximal medical management. There was no cardiovascular instability and a repeat CT scan showed no changes. No specific information regarding outcome prediction was mentioned. Participants were not given information about the objective predicted risks of unfavourable outcomes, as estimated by the CRASH prediction model, in the first part of the structured interview.

Bottom Line: Five hundred healthcare workers with a wide variety of clinical backgrounds participated.Patients' preferences were more similar to patients who had advance directives.The participants' preferences to perform the procedure for themselves and their patients both significantly reduced after knowing the predicted risks of unfavourable outcomes, and the changes in attitude were consistent across different specialties, amount of experience in caring for similar patients, religious backgrounds, and positions in the specialty of the participants.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sir Charles Gairdner Hospital and Royal Perth Hospital, Perth, Western Australia, Australia. stephen.honeybul@health.wa.gov.au

ABSTRACT

Background: Decompressive craniectomy has been traditionally used as a lifesaving rescue treatment in severe traumatic brain injury (TBI). This study assessed whether objective information on long-term prognosis would influence healthcare workers' opinion about using decompressive craniectomy as a lifesaving procedure for patients with severe TBI.

Method: A two-part structured interview was used to assess the participants' opinion to perform decompressive craniectomy for three patients who had very severe TBI. Their opinion was assessed before and after knowing the predicted and observed risks of an unfavourable long-term neurological outcome in various scenarios.

Results: Five hundred healthcare workers with a wide variety of clinical backgrounds participated. The participants were significantly more likely to recommend decompressive craniectomy for their patients than for themselves (mean difference in visual analogue scale [VAS] -1.5, 95% confidence interval -1.3 to -1.6), especially when the next of kin of the patients requested intervention. Patients' preferences were more similar to patients who had advance directives. The participants' preferences to perform the procedure for themselves and their patients both significantly reduced after knowing the predicted risks of unfavourable outcomes, and the changes in attitude were consistent across different specialties, amount of experience in caring for similar patients, religious backgrounds, and positions in the specialty of the participants.

Conclusions: Access to objective information on risk of an unfavourable long-term outcome influenced healthcare workers' decision to recommend decompressive craniectomy, considered as a lifesaving procedure, for patients with very severe TBI.

Show MeSH
Related in: MedlinePlus