TBI-Prognosis

Traumatic brain injury is the leading cause of death and severe disabilities among adults under 45 years of age. Most deaths following severe traumatic brain injury are related with the decision made by families and medical teams to withdraw life-sustaining therapies. Because severe traumatic brain injury occurs mainly in a young healthy population, this decision is likely to be based on the perception of an unfavorable long-term outcome. However, recent practice guidelines and current knowledge showed that our capacity to accurately predict outcome in this population is limited. Our prior work showed a significant variation in the frequency of life-sustaining therapy withdrawals across Canadian trauma centers. More importantly, a significant proportion of deaths occurred in the first 3 days, a time-period considered by several experts as being relatively premature to accurately predict the patient outcome. The purpose of the TBI-Prognosis study is to develop a prognostic model and clinical prediction rule by using a multimodal approach of different prognostic indicators and their evolution over time in the acute phase of care. This study, taking place in 16 Canadian trauma centers, will improve our ability to prognosticate and identify patients who will benefit from aggressive care in the acute phase, and help preventing erroneous evaluation of prognosis that could have lethal consequences when used to decide to pursue or withdraw life-sustaining therapies. For further information, see the TBI-Prognosis website.

References

1. Turgeon AF, Lauzier F, Simard JF, Scales DC, Burns KE, Moore L, Zygun DA, Bernard F, Meade MO, Dung TC, Ratnapalan M, Todd S, Harlock J, Fergusson DA for the Canadian Critical Care Trials Group. Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study. CMAJ. 2011; 183 (14): 1581-1588.
2. Turgeon AF, Lauzier F, Burns K, Meade M, Scales D, Zarychanski R, Moore L, Zygun D, McIntyre L, Kanji S, Hébert P, Murat V, Pagliarello J, Fergusson DA for the Canadian Critical Care Trials Group. Determination of neurological prognosis in adult patients with severe traumatic brain injury: a survey of Canadian intensivists, neurosurgeons and neurologists. Crit Care Med 2013 (In press).
3. Cote N, Turgeon AF, Lauzier F, Moore L, Scales DC, Bernard F, Zarychanski R, Burns KE, Meade MO, Zygun D, Simard JF, Boutin A, Brochu JG, Fergusson DA for the Canadian Critical Care Trials Group. Factors Associated with the Withdrawal of Life-Sustaining Therapies in Patients with Severe Traumatic Brain Injury: A Multicenter Cohort Study. Neurocrit Care. 2012 Oct 26. [Epub ahead of print]
4. Turgeon AF, Lauzier F, Thibodeau M, Rigamonti A, Meade M, Bernard F, Burns K, Reddy K, Scales DC, McIntyre LA, Green R, Griesdale D, Zygun D, Moore L, Savard M, Paquet J, Jichici D, Fergusson DA and the Canadian Critical Care Trials group. Feasibility of a multicenter prospective pilot study on the evaluation of prognosis in severe traumatic brain injury. Critical Care 2012; 16(Suppl 1): P310.

Sean Bagshaw, Francis Bernard, Karen Burns, Dean Fergusson, Robert Green, Donald Griesdale, Jim Kutsogiannis, François Lamontagne, François Lauzier, Claudio Martin, Lauralyn McIntyre, Maureen Meade, Lynne Moore, Véronique Moulin, Giuseppe Pagliarello, Steven Reynolds, Andrea Rigamonti, Martin Savard, Damon Scales, Ryan Zarychanski, David Zygun

CHU de Québec - Hôpital de l’Enfant-Jésus (Quebec city, Quebec), Hôpital du Sacré-Coeur de Montréal (Montreal, Québec), Centre Hospitalier Universitaire de Sherbrooke (Sherbrooke, Quebec), Montreal General (Montreal, Québec), The Ottawa Hospital (Ottawa, Ontario), Sunnybrook Health Sciences Center (Toronto, Ontario), St-Michael's Hospital (Toronto, Ontario), Hamilton Health Sciences Center (Hamilton, Ontario), London Health Sciences Center (London, Ontario), Winnipeg Health Sciences Center (Winnipeg, Manitoba), Foothills Health Sciences Center (Calgary, Alberta), Royal Alexandra Hospital (Edmonton, Alberta), University of Alberta Hospital (Edmonton, Alberta), Vancouver General Hospital (Vancouver, British Columbia), Royal Colombian Hospital (New Westminster, British Columbia), Queen Elizabeth II Health Sciences Center (Halifax, Nova Scotia)

Funding