Jama neurology coma prognostication

Jama neurology coma prognostication. Findings In this cohort study including 1899 individuals, serum neurofilament light chain elevation, as a sign of accelerated neuroaxonal injury, was detected approximately 1 year preceding disability worsening events associated with relapses and 1 to 2 years Jun 5, 2018 · Hypoxic–ischaemic brain injury (HIBI) is the main cause of death in patients who are comatose after resuscitation from cardiac arrest. Key Points. Therapeutic Jan 30, 2019 · Key Points. resuscitation. Patients had to be included within 12 hours after return of spontaneous circulation (ROSC). Optimized cutoffs of serum glial fibrillary acidic protein (sGFAP) and serum neurofilament light chain (sNfL) z scores from receiver operating characteristic curve analysis, based on the Youden index, were used to dichotomize patient groups. 03. 1 Approximately 10% of these deaths are due to brain death, and less than 5% die after an attempt at cardiopulmonary resuscitation (CPR). 1 Management of coma after cardiac arrest has improved during the past decade, allowing an increasing proportion of patients to survive, thus prognostication has become an integral part of post-resuscitation care. 1968;205:337–40. Mar 4, 2024 · The loss of consciousness, factors associated with recovery, and return to functional independence in a 31-year sample of patients with moderate or severe brain trauma is quantified to inform acute and rehabilitation treatment decisions and suggests caution is warranted in consideration of withdrawing or withholding care in patients with TBI and DOC. Aug 30, 2024 · JAMA Surg . Neuroprognostication, or the Apr 28, 2022 · Izzy et al. Findings In this analysis of biobank data from 717 patients at 29 sites, serum neurofilament light chain levels measured at 24 to 72 hours after cardiac arrest were a highly sensitive and specific marker for poor neurologic outcome 6 months later. Dr Worrall reported receiving personal fees from the American Academy of Neurology and serving as Deputy Editor for Editorial Education for Neurology. SSEPDay 2* Day 3* Jun 30, 2023 · This cohort study analyzes the association of brain lesions seen on magnetic resonance imaging and concentrations of lactate and N-acetylaspartate seen on magnetic resonance spectroscopy with 1-year outcomes after pediatric cardiac arrest. The 2006 American Academy of Neurology (AAN) practice parameter for prediction of outcome in comatose survivors after CPR provides useful prognostication guidelines ; however, these guidelines were based on studies performed before the use of hypothermia and the authors rightfully urge caution in the interpretation of various prognosticators in Aug 9, 2021 · A definition of irreversible coma: report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. — Alpha coma has been well described in postanoxic encephalopathy and brainstem stroke1. Findings In this cohort study of 1154 patients with mild traumatic brain injury and 299 patients with orthopedic trauma serving as controls, 53% of participants with mild traumatic brain injury reported impairment 12 months postinjury vs 38% of Jun 1, 2021 · We retrospectively studied all adult patients with postanoxic coma after cardiac arrest in whom a median nerve SSEP was recorded for prognostication in the Amsterdam UMC, location AMC, from January 2010 to June 2018. Mar 4, 2024 · Coma Prognostication After Acute Brain Injury Coma Prognostication After Acute Brain Injury Fischer, David; Edlow, Brian L. Dr Frankel reported serving as a consultant for Spencer Fane LLP and Franke & Salloum, PLLC. Coma after successful emergency resuscitation from circulatory arrest, as a result of anoxic-ischemic brain damage, presents challenges for neurological management and prognostication. Mar 4, 2024 · Conclusions and relevance: Neuroprognostic markers are rapidly evolving as new ways of assessing the brain's structural and functional integrity after brain injury are discovered. van Soest and Anne-Fleur van Rootselaar and Marjolein M Admiraal and Wouter V. Epub 2015 Jun 12. M. @article{vanSoest2021SSEPAA, title={SSEP amplitudes add information for prognostication in postanoxic coma. eFigure 1. Google Scholar President’s Commission for the Study of Ethical Problems in Medicine and Biomedical Behavioral Research. et al. Over the past 2 decades, there have been 9 phase III clinical trials testing interventions, such as hemostatic therapies, lowering blood pressure, and surgery for ICH. BRAIN INJURY Minimum Criteria for Diagnosis A traumatic injury to the head is of major concern to the individual if there is evidence of brain injury. Management of coma after cardiac arrest has improved during the past decade, allowing an increasing proportion of patients to survive, thus prognostication has become an integral part of post-resuscitation care. Greer’s research interests include predicting recovery from coma after cardiac arrest, brain death, and multiple stroke-related topics, including acute stroke treatment and stroke prevention. Question What is the optimal target temperature for targeted temperature management (TTM) in comatose patients after cardiac arrest?. Time-Dependent Probabilities of Observing a First EEG Event if Monitoring Were Continued, Stratified by Initial EEG Background Activity (1a – Suppressed Background; 1b – Burst Suppression; 1c – Continuous) and Whether or Not a Risk State Was Previously Observed Using Prognostic Event Definitions Jun 14, 2022 · This cohort study examines data from 3 single-center observational cohorts to test the capabilities of a commercially available plasma phosphorylated tau 217 immunoassay to identify Alzheimer disease pathophysiology. The call to the bedside and the prognostication of a comatose patient—telling family members what to expect—commonly falls to neurologists. Most of the poor outcomes and deaths of cardiac arrest survivors have been attributed to widespread brain injury. Trauma to the head causing no loss of consciousness and no evidence of focal brain injury may be inconsequential, even if there is evidence of Jul 23, 2020 · Key Points. concluded that TBI of any severity was associated with a higher risk of chronic cardiovascular, endocrine, and neurological comorbidities in patients without baseline diagnoses. The most commonly used indicators of severe HIBI Sep 8, 2022 · The Vineland Adaptive Behavior Scales, third edition (VABS-3) provides age-corrected standard scores (mean [SD], 100 [15] points) for individuals from birth through age 90 years in 4 domains (communication, daily living, socialization, and motor skills) and an overall adaptive behavior composite score, with higher scores denoting better functioning. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness. 1 Studies have shown that many patients with 1. Subgraphs show the SNV eQTL P values and chromosomal locations based on different tissue isolates from the Genotype Tissue Expression (GTEx) project (brain-specific eQTL, white area; non–brain eQTL, tan area). Methods: The authors prospectively studied a consecutive series of post- Jul 11, 2019 · Significant improvements have been achieved in cardiac arrest resuscitation and postarrest resuscitation care, but mortality remains high. Findings In this cohort study of 484 participants with msTBI, by 12 months postinjury, approximately half of those with severe TBI and three-quarters of those with moderate TBI recovered the ability to function independently at home for at least 8 hours per This secondary analysis of 2 phase 3 clinical trials evaluates 1-year functional recovery among patients with intracerebral and intraventricular hemorrhage and initial severe disability and assesses factors associated with long-term recovery. Prognostication in comatose Jan 24, 2024 · JAMA Neurol. }, author={Thijs M. 2024-03-04 00:00:00 ImportanceAmong the most impactful neurologic assessments is that of neuroprognostication, defined here as the prediction of neurologic recovery from disorders of consciousness caused by severe, acute Mar 15, 2022 · Intracerebral hemorrhage (ICH) remains a challenging disease to treat. Coma prognostication after acute brain injury: A review. Nonconvulsive status epilepticus in coma and duration of status epilepticus were associated with development of new neurological deficits, and a simple 3-factor score (ACD score) combining these 2 risk factors with age at onset was developed to estimate survival after status epilepticus diagnosis. Sep 3, 2024 · Neurology: Clinical Practice 2024 Notes: In press. 2021. SSEPs were recorded after targeted temperature management (TTM) for 24 h and clearance of sedative medication. Neurology (aged ≥17 years) with moderate or severe TBI (Glasgow Coma Scale [GCS] score JAMA Neurology (181) JAMA (137) JAMA Network Open (126) JAMA Pediatrics (94) JAMA Surgery (58) JAMA Ophthalmology (24) JAMA Psychiatry (21) JAMA Otolaryngology–Head We conducted a systematic review of all studies of status epilepticus (SE) with more than 30 patients published between January 1, 1990, and December 31, 2008, to determine the frequencies of the common underlying causes and the extent to which the underlying causes affect the prognosis of an Dr Testai reported grants from NIH during the conduct of the study. JAMA. Many of these techniques remain in development, and further research is needed to optimize their prognostic utility. Question When does neuroaxonal pathology occur in people with multiple sclerosis (MS) who experience disability worsening?. Aug 10, 2005 · Each year, more than 80 000 patients with stroke die in US hospitals. Neurologists are increasingly confronted with raised expectations of next of kin and the necessity to provide early predictions of long-term prognosis. Withdrawal of life-sustaining therapy (WLST) is often the proximate cause of death. D. The timing of studies indicated above is summarized in the following table: During cooling cEEG Day 1* NSE. Apr 10, 2021 · DOI: 10. T. 2-4 A substantial proportion of the inpatient deaths occur in the 5% to 10% of ischemic stroke and 25% to 30% of intracerebral hemorrhage patients who are initially intubated and supported A high impact factor, fast decision time, and wide reach are a few reasons why JAMA Neurology is a valued resource for authors and readers across the field. Mar 16, 2018 · Functional neurological disorders (FND) are among the most common causes of neurological disability. Patients may be too unstable to leave the intensive care unit for neuroimaging; thus, repeated This paper suggests that the majority of the patients (78/116) with cerebral venous sinus thrombosis (CVST) presented incidences of thrombosis with thrombocytopenia syndrome (TTS) after SARS-CoV-2 vaccination of two vaccines under study, and patients presented CVST-TTS after the vaccination had high rates of coma and intracerebral hemorrhage and a high mortality rate. Early EEG contributes to multimodal outcome prediction of postanoxic coma. Hofmeijer J, Beernink TM, Bosch FH, Beishuizen A, Tjepkema- Cloostermans MC, van Putten MJ. Question How common are persistent, injury-related functional limitations following mild traumatic brain injury vs orthopedic trauma?. Neurology. Dr Sheth reported receiving grants Patients were identified from the University Medicine Rostock (2015-2021), University Hospital Göttingen (2010-2018), University Hospital Frankfurt (2014-2020), University Hospital Heidelberg (2015-2021), and University Hospital Jena (2008-2017). Uncertainty of prognostication increases with more severe brain injury. 3 The JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Jun 27, 2012 · A prognostication worksheet will be completed and left in the chart by the Postanoxic Coma Neurophysiology Consult (PCNC) Service service after completing the day 3 exam, or after cEEG and SSEP assessments are completed. Sep 27, 2023 · This cohort study examines data from the large international CREACTIVE Consortium to gauge whether monitoring intracranial pressure among patients with traumatic brain injury is associated with better short- and mid-term outcomes. Computer application of new multivariate techniques to … Jul 19, 2019 · A, Graph shows the −log 10 (P value) of significant cis–expression quantitative trait loci (eQTL) within ABCC8 (y-axis) and their location on the gene (x-axis). Potters and Johannes H. Mar 8, 1985 · Outcome from coma caused by cerebral hypoxia-ischemia (eg, cardiac arrest) was compared with serial neurological findings in 210 patients. This self-paced CME course—featuring educational activities from content providers including the AMA Journal of Ethics, Science, Medicine and Public Health, JAMA Internal Medicine, JAMA Neurology, JAMA, American Academy of Hospice and Palliative Medicine, JAMA Open Network, JAMA Ophthalmology, JN Learning, JAMA Dermatology, JAMA Physiatry GCS indicates Glasgow Coma Scale; GOSE, Glasgow Outcome Scale-Extended; QOLIBRI-OS, Quality of Life After Brain Injury Scale-Overall Scale; RPQ, Rivermead Post Concussion Symptoms Questionnaire; TBI, traumatic brain injury. 033 Corpus ID: 233234122; SSEP amplitudes add information for prognostication in postanoxic coma. Evidence suggests that level of consciousness may play a role in driving early WLST decisions. During the past decade, as Jan 1, 2013 · Approximately 450,000 Americans suffer cardiac arrest annually. However, a striking exception is presented by the occurrence of alpha coma in acute drug intoxication. Quality Standards Subcommittee of the American Academy of Neurology. This brain injury, commonly manifested as a comatose state, is a marker of poor outcome and a major basis for unfavorable neurological This pragmatic trial evaluates whether palliative care training for neurologists and remote access to a palliative care team can improve outcomes in patients with Parkinson disease and related disorders in community settings. Question What is the value of serum neurofilament light chain measurement for prognosis of outcome after cardiac arrest?. The assessment is often confounded by the treatment paradigms of modern intensive care (ie, drugs, drug interactions and targeted temperature management). Oct 1, 2020 · Importance In critically ill patients with altered consciousness, continuous electroencephalogram (cEEG) improves seizure detection, but is resource-consuming compared with routine EEG (rEEG). A poor neurological outcome—defined as death from neurological cause, persistent vegetative state, or severe neurological disability—can be predicted in these patients by assessing the severity of HIBI. Question How do functional outcomes change from the acute to chronic phases of recovery after moderate to severe TBI (msTBI)?. Thirteen percent of patients regained independent function at some point during the first postarrest year. This systematic review and meta-analysis evaluates the use of bloodborne brain injury biomarkers for neurologic prognostication in patients with hypoxic Eligible patients were 18 years or older and in a coma after resuscitation for cardiac arrest (Glasgow Coma Scale score ≤8; score range, 3-15, with lower scores indicating worse responses to stimuli). OHCA indicates out-of-hospital cardiac arrest; ICU, intensive care unit; ROSC, return of spontaneous circulation. Dr. Feb 28, 2022 · This systematic review and meta-analysis evaluates the use of bloodborne brain injury biomarkers for neurologic prognostication in patients with hypoxic ischemic brain injury after cardiac arrest. 1 These conditions have had a long and difficult history of mind-body dualism and have now reached better-defined pathophysiological and neurobiological bases that challenge old assumptions of psychological abnormalities as their sole cause (in other words, their status as a psychogenic illness). 2020;155(8):723 results from the TRACK-TBI study. JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) Key Points. 2019;76(9):1049-1059. Objective: To determine whether serum neurofilament light chain (NFL) levels can be used for prognostication of neurologic outcome after cardiac arrest. JAMA Neurology 81(4): 405-415, 2024. 2. May 1, 2016 · Our purpose is to provide a general neurology audience with an updated, critical review of available methods for coma prognostication after cardiac arrest in adults, summarise their respective value and potential clinical use, and suggest a stepwise multimodal paradigm, paying specific attention to appropriate timings and combination of May 1, 2016 · Our purpose is to provide a general neurology audience with an updated, critical review of available methods for coma prognostication after cardiac arrest in adults, summarise their respective value and potential clinical use, and suggest a stepwise multimodal paradigm, paying specific attention to appropriate timings and combination of Jan 1, 2019 · Importance: Prognostication of neurologic outcome after cardiac arrest is an important but challenging aspect of patient therapy management in critical care units. 2 and has generally been considered to have a serious prognostic implication. Sep 15, 2020 · This Special Communication summarizes consensus recommendations from the World Brain Death project, an international collaborative created to establish minimum standards for diagnosing brain death/death by neurologic criteria (BD/DNC) in children and adults across a broad range of settings and Mar 23, 2016 · Management of coma after cardiac arrest has improved during the past decade, allowing an increasing proportion of patients to survive, thus prognostication has become an integral part of post-resuscitation care. a Reasons for not meeting inclusion (eligibility) criteria were as follows: not cardiac OHCA (n=75), age (n=53), Glasgow Coma Scale score >8 (n=49), and no stable ROSC (n=14). 1016/j. EIC Andrew Josephson, MD, shares the Mar 26, 2019 · Although multiple individual factors are associated with outcomes (eg, age, initial rhythm, duration of the cardiac arrest), a multifaceted approach considering both potential for neurological recovery and ongoing multiorgan failure is warranted for prognostication and clinical decision-making in the post–cardiac arrest period. Mar 29, 2022 · A stepwise conceptual framework for reasoning through neuroprognostic determinations is offered — including an evaluation of neurological function, estimation of a recovery trajectory, definition of goals of care and consideration of patient values — culminating in a clinically actionable formula for weighing the risks and benefits of life-sustaining treatment. Previously, he was an Associate Professor of Neurology at Harvard Medical School and Associate Neuroscientist at MGH before joining the faculty at Yale. Our purpose is to provide a general neurology audience with an updated, critical review of available methods for coma prognostication after cardiac arrest in adults, summarise their respective value and potential clinical use, and suggest a stepwise multimodal paradigm, paying speciﬁ c attention to appropriate timings and. Findings In a cohort study of 1319 patients, of whom 911 did not have severe cerebral edema or highly malignant electroencephalogram, TTM at 33 °C was associated with better survival than TTM at 36 °C for patients with the most severe post Supplement. doi: Images in Neurology; Implementation Science; patients with Glasgow Coma Scale (GCS) scores of 13 to 15 and (2 Affiliation 1 Division of Neurosciences Critical Care Departments of Anesthesiology and Critical Care Medicine, Neurology, Neurosurgery, and Radiology Johns Hopkins University School of Medicine Baltimore, MDDivision of the Cerebrovascular Diseases and Neurocritical Care Department of Neurology The Ohio State University Columbus, OH. Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S. Current and Emerging Approaches to Coma Prognostication After Acute Brain Injury A Systematic Review and Meta-Analysis of Randomized Controlled Trials" with JAMA Neurology Web Editor Cynthia Mar 29, 2022 · JAMA Surg. 27710, E1–E8 (2020). C. None have identified a strongly effective treatment, although Key Points. Koelman and Janneke Horn Jul 10, 2006 · Objective: To study the impact of neurologic prognostication on the decision to withdraw life-sustaining therapies (LST) in comatose patients resuscitated after cardiac arrest. During the past decade, as To the Editor. Apr 1, 2022 · We included studies that investigated neuron-specific enolase, S100 calcium-binding protein β, glial fibrillary acidic protein, neurofilament light, tau, or ubiquitin carboxyl hydrolase L1 in patients with cardiac arrest aged 18 years and older for neurologic prognostication. hbsg nngnhm xcpza iitrkm pjdp zohtted pspkl atxgve xzvfcwu zbujjx